Irritable Bowel Syndrome

Question 1

What is irritable bowel syndrome (IBS)?

Answer 1

It is defined as a functional bowel disorder, in which there is no identifiable disease pathology underlying clinical features

Question 2

What are the six risk factors of irritable bowel syndrome?

Answer 2

Female Gender

Young Age

Family History

Anxiety

Depression

Stress

Question 3

What are the nine clinical features of irritable bowel syndrome?

Answer 3

Fatigue

Nausea

Abdominal Pain

Abdominal Bloating

Change In Bowel Habit

Faecal Urgency

Tenesmus

Faecal Mucus

Bladder Features

Question 4

What are the two characteristics of irritable bowel syndrome clinical features?

Answer 4

The clinical features improve upon defecation

The clinical features worsen upon eating

Question 5

What two investigations are used to diagnose irritable bowel syndrome?

Answer 5

Blood Tests

Stool Culture

Question 6

What four blood test results indicative of irritable bowel syndrome?

Answer 6

Normal FBC

Normal ESR Levels

Normal CRP Levels

Negative Coeliac Disease Serology

Question 7

What is the first line investigation of irritable bowel syndrome?

Answer 7

Anti-TGG levels

Question 8

What two stool tests are used to diagnose irritable bowel syndrome?

Answer 8

Faecal Calprotectin

Stool Culture

Question 9

What is faecal calprotectin?

Answer 9

It is an inflammatory marker, which is released during colitis

Question 10

How is faecal calprotectin used to diagnose irritable bowel syndrome?

Answer 10

It is used to exclude inflammatory bowel disease, which would demonstrate elevated levels of this inflammatory marker

Question 11

How is a stool culture used to diagnose irritable bowel syndrome?

Answer 11

It is used to exclude gastrointestinal infections

Question 12

What is the diagnostic criteria required for irritable bowel syndrome?

Answer 12

A diagnosis is obtained in cases where individuals present with a six month history of abdominal pain, which is relieved by defecation or associated with a change in bowel habit.

In addition, individuals should be meet two of the following criteria…

• Abnormal Stool Passage
• Abdominal Bloating
• Clinical Features Worsening Upon Eating
• Mucus Within Stools

Question 13

What are the five conservative management options for irritable bowel syndrome?

Answer 13

Disease Education & Reassurance

Cognitive Behavioural Therapy (CBT)

Dietary Advice

Increased Fluid intake

Alcohol Cessation

Question 14

When is CBT recommended to manage irritable bowel syndrome?

Answer 14

In cases where clinical features dont respond to pharmacological treatments after 12 months and who develop a continuing clinical profile

Question 15

What six dietary recommendations are used to manage irritable bowel syndrome?

Answer 15

Regular meals

Restrict tea and coffee to three cups per day

Reduce alcohol and fizzy drink intake

Limit intake of high-fibre food

Reduce intake of resistant starch, often found in processed foods

Limit fresh fruit to three portions per day

Question 16

What are the five pharmacological management options for irritable bowel syndrome?

Answer 16

Antidiarrheal Medications

Laxatives

Antispasmodics

Tricyclic Antidepressants (TCAs)

Selective Serotonin Reuptake Inhibitors (SSRIs)

Question 17

When are antidiarrheals used to manage irritable bowel syndrome?

Answer 17

They are the first line pharmacological management option

Question 18

How are antidiarrheals used to manage irritable bowel syndrome?

Answer 18

It is used to symptomatically manage diarrhoea

Question 19

Name an antidiarrheal medication used to manage irritable bowel syndrome

Answer 19

Loperamide

Question 20

When are laxatives used to manage irritable bowel syndrome?

Answer 20

They are the first line pharmacological management option

Question 21

How are laxatives used to manage irritable bowel syndrome?

Answer 21

It is used to symptomatically manage constipation

Question 22

Name four laxatives used to manage irritable bowel syndrome

Answer 22

Isphagula Husk

Bisacodyl

Senna

Sodium Picosulfate

Question 23

What is the first line bulk-forming laxative used to manage irritable bowel syndrome?

Answer 23

Isphaghula Husk

Question 24

What laxative is used when individuals with constipation are not responding to conventional laxatives? What are the two criteria required?

Answer 24

Linaclotide

The optimal tolerated doses of previous laxatives from different classes have not improved clinical features

They have had constipation for at least 12 months

Question 25

When are antispasmodics used to manage irritable bowel syndrome?

Answer 25

They are the first line pharmacological management option

Question 26

How are antispasmodics used to manage irritable bowel syndrome?

Answer 26

It is used to symptomatically manage abdominal pain

Question 27

Name an antispasmodics used to manage irritable bowel syndrome

Answer 27

Hyoscine butylbromide

Question 28

When are tricyclic antidepressants used to manage irritable bowel syndrome?

Answer 28

They are the second line pharmacological management option

Question 29

How are tricyclic antidepressants used to manage irritable bowel syndrome?

Answer 29

They are used to manage risk factors, such as anxiety and depression

Question 30

Name a tricyclic antidepressant used to manage irritable bowel syndrome. What dose is recommended?

Answer 30

Amitriptyline

Low dose 5mg - 10mg

Question 31

When are SSRIs used to manage irritable bowel syndrome?

Answer 31

They are the third line pharmacological management option

Question 32

How are SSRIs used to manage irritable bowel syndrome?

Answer 32

They are used to manage risk factors, such as anxiety and depression

Question 33

Name two SSRIs used to manage irritable bowel syndrome

Answer 33

Fluoxetine

Sertraline