Irritable bowel syndrome

Question 1

What is IBS

Answer 1

chronic condition charcterised by recurrent abdominal pain associated with bowel dysfunction

Question 2

What are the different types of IBS

Answer 2

IBS-D with diarrhoea
IBS-C- with constipation
IBS-M- mixed

Question 3

What are risk factors

Answer 3

history of abuse
PTSD
bacterial gastroenteritis
family history
affects females more than males

Question 4

What may someone with IBS present with

Answer 4

cramping in lower/mid abdomen
alteration of stool consistency
defecation relieves abdominal pain/discomfort

normal on examination

Question 5

when should a diagnosis of IBS be considered

Answer 5

if patient has had the following for at least 6 months

• abdominal pain and/or,
  -bloating and/or
  -change in bowel habit

Question 6

when should a positive diagnosis of IBS be made

Answer 6

if patient has abdominal pain relieved by defecation/associated with altered bowel frequency stool form -
as well as 2/4 symptoms

• altered stool passage
  -abdominal bloating - distension,tension or hardness

-symptoms made worse by eating

-passage of mucus

Question 7

What other symptoms may aid the diagnosis

Answer 7

features such as lethargy, nausea, backache and bladder symptoms

Question 8

What investigations are required

Answer 8

IBS is a diagnosis of exclusion

exclude coeliac with anti-tTG

exclude IBD with faecal calprotectin, lactoferrin, CRP, colonoscopy

exclude colorectal cancer with FBC and FOB test

Question 9

What lifestyle management is needed

Answer 9

increase fibre
avoid caffeine, lactose, fructose
stress management
avoid sorbitol if they have diarrhoea

Question 10

What medical management can be given

Answer 10

First line pharmacological treatment – according to predominant symptom

-pain - antispasmodic agents
-constipation - laxatives but avoid lactulose

-diarrhoea - loperamide is first line

Second line pharmacological treatment
-low dose tricyclic antidepressant ( amitriptyline 5-10mg )

Question 11

What are some other management options for IBS

Answer 11

psychological interventions -
if no response to pharmacological treatments after a year and those who develop continuing symptom profile

consider
COBT,hypnotherapy or psychological therapy

Question 12

What test should be used in primary care to differentiate IBS and IBD

Answer 12

faecal calprotectin -
it is released in bowel in presence of inflammation and is not degraded so can be detected in a stool sample

reduces need for referral of patients with typical IBS symptoms and use of invasive diagnostic testing