IBS

Question 1

Main presenting symptoms of Irritable Bowel Syndrome (IBS)

Answer 1

• abdominal pain relieved by defecation
• associated with altered bowel habit

+/- 2 of the following
- altered stool passage (urgency, incomplete evacuation)
- abdominal bloating
- symptoms made worse by eating
- PR mucus

Question 2

Red flag features to consider before a diagnosis of IBS

Answer 2

• rectal bleeding
• unexplained/unintentional weight loss
• family history of bowel or ovarian cancer
• onset after 60 years of age

Question 3

What investigations may be used in Primary care to confirm/rule out IBS

Answer 3

• full blood count
• ESR/CRP
• coeliac disease screen (tissue transglutaminase antibodies)

Question 4

Management of pain, constipation and diarrhoea in IBS

Answer 4

pain: antispasmodic agents

constipation: laxatives but avoid lactulose

diarrhoea: loperamide

2nd Line: low-dose tricyclic antidepressants

Question 5

Dietary advice for IBS

Answer 5

• regular meals
• take time to eat
• 8 cups of fluid per day
• restrict caffeine/fizzy drink intake
• limit high-fibre food/ fresh fruit
  for diarrhoea
• avoid sorbitol
• for wind and bloating consider increasing intake of oats