IBS Flashcards
(22 cards)
What is IBS
IBS is chronic, relapsing and often lifelong GI disorder. It has been reclassified as a disorder of the gut-brain interaction
What are symptoms of IBS
Abdominal pain
Bloating
tenesmus
changes in bowel habits - diarrhea, constipation, urgency.
What are the IBS subtypes
Use the role of >25% over a two week period
IBS with predominant diarrhea
IBS with predominant constipation
IBS with mixed bowel habits.
What is the aetiology of IBS
Genetics
stress
dysbiosis of the gut microbiota
overlap with chronic pain and mental health disorders e.g PCOS, anxiety, fibromyalgia
Dietary and lifestyle factors
What causes dysbiosis of the gut microbiota.
Post infection illness, antibiotic use travel, poor diet, stress, fad or restrictive diets.
Red flag symptoms.
Blood in stool
family hisotry of colon cancer
unexplained weight loss
rectal/abdominal masses
inflammatory markers for IBS
What diagnostic tests should be undertaken to exclude other diagnoses.
- full blood count
- electrolyte sedimentation rate
- CRP
- antibody testing for coeliac disease.
Could also undertake fecal calprotectin test which is used to assess for inflammation in the intestines which often occurs due to IBD or could test for fecal elastase which assessed pancreatic exocrine function
What is SIBO
When excess bacteria builds up in the small intestine.
Produces gas higher up in the intestine. Usually diagnosed using a breath test
What is the pharmaological management of IBS
- Antispasmodics - buscpan, peppermint oil
- Laxatives - used for constipation - senna, fybrogel, Movicol
- antimotility - for diarrhea e.g. Imodium.
- lose dose antidepressants if other therapies have not work
Explain the nutritional assessment for a patient with IBS.
Anthro - weight, BMI, weight history
Biochem: FBC, ESR, CPR, antibody testing for coeliac disease, FCP, fecal elastase.
Clinical: symptom assessment, PMH, medications (can cause GI side effects), supplements.
Dietary: dietary assessment - check for healthy eating, food intolerances (milk), fibre, fatty foods, spicy foods, alcohol, coffee, fluid
environment: Environmental factors such as the brain gut axis, hypersensitivity.
Explain how you would carry out a symptom assessment.
Need to ask about pain, stool type, frequency, urgency, tenesmus, bloating, flatulence.
Could keep a food and symptom diary to explore triggers.
What are common triggers of IBS
fatty/greasy foods, spicy foods, caffeine, alcohol, fiber.
What is the first line dietary advice.
Have regular meals
Avoid missing meals or having long gaps between meals
limit tea and coffee intake to 3 cups a day
have >8 cups of fluid per day
May need to restrict fibre intake, particularly resistant starch
<3 portions of fruit a day
Explain lactose intolerance and IBS
Consider a trail of a low lactose diet if lactose is a suspected trigger
May be useful in individuals with an ethnic background where there is a higher prevalnce of lactase deficiency
Lactose breath tests are available for diagnoses.
explain fiber and IBS
Individual tolerance to fiber varies - may ne to increase or decrease intake.
If increase in dietary fiber is advised, need to increase fluid intake and it should be soluble fiber
Need to think about overall fiber intake & fiber distribution across meals.
Explain methods of helping with IBS-C
Could trail flaxseeds, chia seeds to psyllium - has been shown to improve stool consistently and frequency.
Start with half a tablespoon and work up to 2 tablespoons.
What are some implications of food restriction
- Decreased macro and micronutrient intake
-reduced diversity of gut microbiota - impact on social settings and relationships
- exacerbation of symptoms due to anxiety
What are non-dietary approaches
- signposting - talking therapies, CBT
- apps such as nerva, headspace
- yoga
- diaphragmatic breathing - deep breaths before meals - want diaphragm and stomach working together
- toilet positioning
- toilet plan - I can’t wait card, change of clothes, map of public toilets
- bowel massage.
- pelvic health physio.
What are FODMAPs
- they are short chain fermentable CHO
- They are poorly absorbed leading to fermentation in osmotic shifts in the gut
- people suffer with symptoms due to gut hypersensitivity
What does FODMAP stand for and give examples of foods that should be excluded.
Fermentable - process through which bacteria ferment undigested CHO, producing gas
Oligosaccharides - fructans & GOS - found in wheat, rye, onions, garlic, legumes, pulses
Disaccharides - lactose - found in dairy products such as milk, yoghurt, soft cheese
Monosaccharide - fructose - found in honey, apples, corn syrup
And
Polyols - sorbitol and mannitol, found in some fruit and veg and used as artificial sweeteners.
What are the stages of the low FODMAP diet
Phase 1 - restriction of high FODMAP foods for 4-8 weeks
- resources and advice and suitable food alternatives are important
phase 2 - reintroduction of FODMAPS - if symptoms improve, reintroduce each FODMAP one at a time. Explore possible dietary triggers and in what frequency and quantity
Phase 3: personalized FODMAP diet - important to keep as much variation in the diet as possible.
Why is important to reintroduce FODMAP foods
May high FODMAP foods are high in natural prebiotics which promote the growth of good bacteria in the bowel
It avoids unnecessary food restriction and helps ensure the patients has a varied and nutritious diet.
