IBS

Question 1

what is the diagnostic criteria for IBS?

Answer 1

abdominal pain relieved by defecation or associated with altered bowel frequency stool form + 2 or more of the following;

• made worse by eating
• passage of mucous
• abdominal bloating, distension, tension or hardness
• altered stool passage (urgency, straining, incomplete evacuation)

Question 2

what are red flag symptoms?

Answer 2

onset > 60yrs
family history of ovarian or colon cancer
passage of blood
unexplained/ unintentional weight loss

Question 3

what tests might you do in primary care when someone presents with symptoms of IBS?

Answer 3

FBC
CRP/ESR
coeliac screen (anti-TTG)

Question 4

what is the 1st line treatment for IBS?

Answer 4

depends on predominant symptom;

• constipation: osmotic laxative (avoid lactulose)
• pain: antispasmodic i.e. buscopan
• diarrhoea: Loperamide

Question 5

what is 2nd line treatment for IBS-c and what is the indications or 2nd line treatment?

Answer 5

if optimal tolerated dose of previous laxative from different classes have not worked and constipation for > 12 months

2nd line: Linaclotide

Question 6

what is 2nd line treatment for IBS?

Answer 6

tricyclic antidepressants e.g. Amitriptyline