irritable bowel syndrome

Question 1

intro

Answer 1

functional GI disorder without a specific organ issue

has a symptom based diagnostic criteria, without organic causes

Question 2

peak incidence in

Answer 2

20-30yo
more common in women

Question 3

risk factors

Answer 3

• female sex
• severity and duration of infectious diarrhoea
• pre-exisiting adverse life events
• high hypochondrial/neurotic scores at time of diagnosis

Question 4

types of IBS

Answer 4

• IBS-C w/ constipation, more hard stools
• IBS-D w/ diarrhoea, more loose stools
• IBS-M mixed, both hard and soft stools

Question 5

aetiology (causes)

Answer 5

• GI motility disorders
• enhanced visceral perception (brain-gut axis)
• microbial dysbiosis
• abnormal SMC activity w/ visceral hypersensitivity + abnormal central processing of painful stimuli

Question 6

defined as

Answer 6

IBS = presence of abdominal pain related to defecation, associated with a change in stool frequency/form

Question 7

symptoms

Answer 7

• abdominal pain
• lethargy
• nausea
• backache
• bladder symptoms
• morning rush - urgency to defecate, in + after breakfast
• GYNAE = dysmenorrhoea, dyspareunia
• URINARY = frequency, urgency, nocturia
• EXTRA-INTESTINAL = headaches, migraines, joint hypermobility, asthma, backache + psychological anxiety/depression

Question 8

red flag symptoms

Answer 8

• rectal bleeding
• unexplained weight loss
• FH of bowel/ovarian cancer
• onset after 60yo age

Question 9

signs

Answer 9

• abdominal exam + DRE helps exclude other diagnoses
• dyssynergic defecation (paradoxical contraction during straining) or low rectal masses

Question 10

diagnosis

Answer 10

clinical - based on symptoms
diagnosis considered if pt has ABC for 6 months
* Abdominal pain
* Bloating
* Change in bowel habit

Question 11

positive diagnosis of IBS if abdo pain

Answer 11

• relieved by defecation
• assoc wtih change in form/ frequency of stool

+

• altered stool passage (straining, urgency, incomplete evacuation)
• abdominal bloating
• passing mucus
• symptoms worsened by eating

Question 12

differential diagnosis

Answer 12

• colon cancer
• IBD = CD, UC
• coeliac disease
• gastroenteritis
• diverticular disease
• bile acid malabsorption
• gut NET eg. carcinoid
• gynac issues eg. PID, endometriosis, ovarian tumours

Question 13

investigations

Answer 13

BLOODS
* FBC
* ESR
* CRP
* EMAs/TTG (antibody testing for coeliac disease)
* CA-125 (exclude ovarian cancer if symptomatic)
* faecal calprotectin (exclude IBD if symptoms)

• ask abt FH of IBD/colon cancer to speed up referrals

Question 14

management

Answer 14

• lifestyle and dietary changes for mild-moderate symptoms
• pharmacological therapy for more severe

Question 15

first line = diet advice

Answer 15

• ** regular meals
• 8 cups of fluid a day
• reduce alcohol/fizzy drinks
• limit high-fibre foods
• reduce caffeine to 3 cups a day**
• avoid missing/long gaps between meals
• diarrhoea - avoid sorbitol
• wind/bloating - increase oats, lindseeds

Question 16

diets to follow

Answer 16

• high fibre diet
• fibre supplements for constipation
• low FODMAP diet for bloating

Question 17

next line = PHARMACOLOGICAL mgt

Answer 17

based on symptom
* PAIN/colic/bloating = antispasmodics (alverine)
* constipation = laxatives eg. linaclotide (avoid lactulose)
* diarrhoea = loperamide

Question 18

alternative, next step meds given for continuing symptoms

Answer 18

• refractory abdo pain = give antidepressants + SSRI
• low dose tricyclic antidepressants (amitriptyline 5-10mg)
• SSRI (citalopram)
• diarrhoea = ondansetron
• constipation = tegaserod

Question 19

non-pharm mgt

Answer 19

• lifestyle/dietary measures
• cognitive therapy - CBT

treat symptoms
* constipation - increase water and fibre, exercise, laxatives (not lactulose)
* diarrhoea - reduce fibre, identify triggers, bulking agent
* bloating - oral antispasmodics