Flashcards in Irritable Bowel Syndrome Deck (17)
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1
Three Sub-Types of IBS
Diarrhoea predominant
Constipation predominant
Mixture between the two
2
Pathophysiology
genes + ENVIRONMENT
disturbed GI motility
Visceral hypersensitivity
3
Viceral Hypersensitivity
Seen in 2/3 of patients
Mechanisms =
Peripheral sensitisation
Central sensitisation
4
Rome III Criteria for IBS
Recurrent abdo pain/discomfort for at least 3 days per month for 3 months + 2 or more of:
Improvement with defecation
Change in stool frequency
Change in stool form (appearance)
5
Additional Symptoms
Bloating
Urgency
Sensation of incomplete emptying
Mucus per rectum
Nocturia (and poor sleep)
Aggravated by stress
6
Associated Illnesses
Fibromyalgia
Chronic fatigue syndrome
Temporomandibular joint dysfunction
Chronic pelvic pain
7
Psychological Features
Depression
Anxiety
Hypochondriacal
8
History
Bowel habit
Bloating, nocturia
Diet (bread, fibre, bizarre exclusions)
Trigger factors (infection, menstruation, drugs)
Opiate use
Psychosocial factors (stress)
Underlying fears ("cancer")
9
Red Flags
Age >50
Short duration of symptoms
Woken from sleep by altered bowel habit
Rectal bleeding
Weight loss
Anaemia
FH of colorectal cancer
Recent antibiotics
10
Investigations
FBC
ESR/plasma viscosity
CRP
Antibody testing for coeliac disease
Red flags = Lower GI investigations
11
Treatment - Diet
Regular meal times
Reduce fibre intake
Restrict tea and coffee intake
Reduce intake of "resistant starch"
If diarrhoea, avoid sorbitol
Persistent symptoms = consider single food avoidance and exclusion diets (e.g. low FODMAP diet)
12
Treatment - Drugs
Stop opiate analgesia
Anti-diarrhoeals
Anti-spasmodics
Anti-depressants
13
Laxatives
Lactulose promotes flatulence
PEG based are better as effect doesn't wear off
14
Anti-Diarrhoeals
Loperamide
Inhibits peristalsis, gut secretions
Benefits diarrhoea
Use PRN/prophylactically
15
Anti-Depressants
Tricyclics
Reduce diarrhoea
Reduce pain
Help restore sleeping pattern
Side effects =
Dry mouth
Fatigue
Solomance
16
Psychological Treatment
If severe anxiety/depression and no response to anti-depressants
Relaxation therapy
Cognitive behavioural therapy
Hypnosis
17
