Irritable Bowel Syndrome IBS

Question 1

What is IBS?

Answer 1

Abdominal symptoms for which no cause can be found.

People with IBS often have an excessive awareness of normal digestive processes.

Question 2

IBS Prevalence

Answer 2

10%

Question 3

Causes of IBS

Answer 3

Visceral Hypersensitivity
Stress
Anxiety
Altered Motility
Depression.

Question 4

IBS Symptoms

Answer 4

• > Abdominal Pain (which is variable - eg. burning/sharp/bloating, and occasionally radiates to the lower back)
• > Abdominal Bloating (Belching Wind and Flatus, and Mucus in Stool)
• > Altered Bowel Habit (eg. constipation/diarrhoea/both constipation and diarrhoea).

(Symptoms of IBS usually occur in a chronic relapsing, and remitting manner).

Question 5

NICE Diagnostic Criteria: IBS

Answer 5

Abdominal Pain which is relieved by defecation or associated with altered stool frequency/form, plus two or more of:

• Abdominal bloating/distension,
• Altered stool passage,
• Symptoms made worse by eating
• Passage of mucus.

Question 6

Investigations: IBS

Answer 6

Stool Culture, Calprotectin (allows differentiation between IBS and IBD - raised in IBD), Blood analysis (FBC, U&E, LFTs, Ca, CRP, TFTs), Ultrasound, Coeliac serology etc…

Question 7

Treatment: IBS

Answer 7

Treatment:
- Healthy diet (reduce alcohol, fizzy drinks, starch, wheat, lactose, caffeine). - Psychological intervention = CBT, PIT, Relaxation training, Hypnotherapy.
- Treat symptoms:
- Abdominal Pain = Antispasmodics, Linaclotide, Anti-depressants.
- Bloating = Probiotics, Linaclotide.
(AVOID BULKING AGENTS/FIBRE)
- Constipation = Laxatives, Linaclotide.
(AVOID TCA, FODMAP)
- Diarrhoea = Antimotility agents (Loperamide), FODMAP.
(AVOID SORBITAL SWEETENERS)