IBS Flashcards
Thediagnosis of IBS should be considered if the patient has had the followingfor at least 6 months:
- Abdominal pain, and/or
- Bloating, and/or
- Change in bowel habit
ABC
A positive diagnosis of IBS should be made if the patient has abdominal pain relieved by defecation or associated with altered bowel frequency stool form, in addition to 2 of the following 4 symptoms:
- altered stool passage (straining, urgency, incomplete evacuation)
- abdominal bloating (more common in women than men), distension, tension or hardness
- symptoms made worse by eating
- passage of mucus
Features such as lethargy, nausea, backache and bladder symptoms may also support the diagnosis
Red flag features should be enquired about:
- rectal bleeding
- unexplained/unintentional weight loss
- family history of bowel or ovarian cancer
- onset after 60 years of age
Suggested primary care investigations are:
- full blood count
- ESR/CRP
- c-reactive protein (CRP)
- antibody testing for coeliac disease screen (TTG’Ys - tissue transglutaminase antibodies)
common presentation case: 20 year old woman presents with recurrent episodes of abdominal pain associated with bloating. the pain is relieved on defecation. she normally passes 3 loose stools with mucous in the mornings
IBS
5 symptoms specific to IBS
Bloating
Altered bowel habit
PR mucus
Worse after meal
Better after defecation
IBS management includes?
1st line:
Loperamide - Diarrhoea
Senna - Constipation
Buscopan (hoscine butylbromide) - Cramps
NOT Lactulose
2nd line
TCAs
SSRIs
….CBT?
What medication should you NOT give to patients with IBS and why
Lactulose
Lactulose increases gas and bloating in the stomach, which can make IBS worse.
Lactulose is a type of laxative called an osmotic laxative. It is broken down in your bowel into substances that pull water out from your body and into your bowel to soften poo and make it easier to pass.
Red flags needing referral with IBS
Unintentional and unexplained weight
Rectal bleeding
Family Hx bowel/ ovarian cancer
Change in bowel habit to looser and/or frequent stools persisting >6 weeks in person >60 year
Anaemia
Raised inflammatory markers
Abdominal/rectal masses
If symptoms may suggest ovarian cancer - pelvic examination
People with IBS should be given information that explains the importance of self-help in effectively managing their IBS. this should include information on:
- General lifestyle
- Physical activity
- Diet
- Symptom
Diet + physical activity main ideas
Encourage identification of leisure and relaxation time
Assess physical activity levels eg general practice physical activity questionnaire (GPPAQ)
Review fibre intake and adjust (usually reduce) according to symptoms
Referral to Dietition
If diet is considered a major factor in symptoms and dietary/lifetyle advice is being followed, refer to a dietitian for single food avoidance and exclusion
FODMAPs diet may be explored
Medications
First line: single or combination medication based on the predominant symptoms:
Consider Antispasmodic agents, eg mebeverine, buscopan
- taken as required alongside dietary and lifestyle advice
- limited evidence base
Consider laxatives for constipation eg magnesium hydroxide, senna, isphalgua hust (fybogel) but discourage use of lactulose
Offer loperamide as the first choice of anti-motility agent for diarrhoea
Advise people how to adjust doses of laxative or anti-motility agent according to response, shown by stool consistency
Aim is a soft, well-formed stool
- (Bristol Stool form scale type 4)
Unexplained/unintentional weight loss
10% lost in 6 months general rule
5% lost in 5 months
Even if patient thinks they have coeliac’s
