Lecture 4 - IBS

Question 1

what are the comorbidities with IBS ?

Answer 1

Anxiety. Panic disorders, depression
Fibromyalgia
IBD Colitis
Celiac Disease

Question 2

What is the pathophysiology of IBS ?

Answer 2

Visceral hypersensitivity + lower pain threshold
CNS+ ENS
⬇5HT3 receptors in the GI tract
NO filtering
SIBO

Question 3

What is the SIBO ?

Answer 3

Small intestine bacterial overgrowth

Question 4

What are the symptoms of IBS ?

Answer 4

Abnormal or infrequent bowel movement
Lower abdominal pain ( general, relief after defecation, worse with meals )
Bloating and flatulence
Dyspepsia, urinary symptoms, fatigue and painful urination

Question 5

Which of the following symptoms will indicated that it is NOT IBS ?

Answer 5

Blood in stool
Fever, severe abdominal pain
First @ >50 yo
Nocturnal symptoms ( at that time the GI is at rest )
Fever
Unexplained weight loss

Question 6

what does the ROME IV criteria says ?

Answer 6

Abdominal pain + discomfort → altered bowel habits for 3 months

Question 7

What diagnostic test that should not be done ?

Answer 7

Colonoscopy
fecal occult blood
ova/parasite stool test
food allergies

Question 8

what are the various tools for the diagnosis of IBS ?

Answer 8

History + SCHOLARE
CBC / differential
CRP/ fecal lactoferrin to rule our IBD
IgA TtG

Question 9

What is the threshold for categorizing IBS ?

Answer 9

25%

Question 10

Name various ways to help IBS through psychological methods ?

Answer 10

cognitive behaviour
hypnosis
relaxation
meditation
mindfulness

Question 11

Is caffeine a trigger for IBS ?

Answer 11

eventhou caffeine increase GUT motility , there is no evidence that it worsens IBS

Question 12

What lifestyle changes can help with IBS?

Answer 12

moderate physical activity
avoid binge drinking

Question 13

In terms of diet , what can we do to help with IBS ?

Answer 13

higher fibre
low FODMAPS
smaller meals
decrease flatulence

Question 14

What is FODMAPS ?

Answer 14

fermentable oligo di and monosaccharides and polyols

Question 15

Provide examples of LOW FODMAPS ?

Answer 15

banana
tomatoes
egg plant
fish, meat, chicken , grapes

Question 16

Example of high FODMAPS?

Answer 16

legumes, apples, ice cream , coconut,

Question 17

How can prebiotics help with IBS?

Answer 17

reduce the gas and bloating

Question 18

How can probiotics help with IBS ?

Answer 18

reduce the inflammation, painful sensation, abdominal pain, bloating and bowel habits

Question 19

How much of water soluble fibre if beneficial to IBS pts?

Answer 19

15-20g / day

Question 20

name some water soluble fibers ?

Answer 20

“psyllium, methylcellulose, polycarbophil
beans, apples, zucchini, blueberries “

Question 21

Why would we try to avoid stimulants laxative for IBS ?

Answer 21

more cramping in some patients

Question 22

which among the laxatives would be the best for IBS ?

Answer 22

Osmotic laxative ( 1–> PEG) ( 2–> Lactulose)

Question 23

what is the MOA of linaclotide ?

Answer 23

GCC agonist and increases secretion and motility
pulls water into the lumen

Question 24

What drug class is “Linaclotide and plecanatide ?

Answer 24

GC-C agonists

Question 25

Efficacy of GC-C agonsit

Answer 25

improvement in the bowel movement and abdominal symptoms take longer

Question 26

When can you expect GC-C to start working ?

Answer 26

1 week

Question 27

what is the indication for 5HT4 agonists ?

Answer 27

Prucalopride, Severe constipation in women with IBS-C

Question 28

what is the indcation for cholestyramine ?

Answer 28

for IBS , if bile acid malabsorption or the removal of gallbladder

Question 29

what and why is rifaximin used in IBS-D ?

Answer 29

poorly absorbed Abx that influences gut microflora

Question 30

Eluxadoline is used for ?

Answer 30

IBS-D
mu and beta opioid antagonist

Question 31

What are the contraindication of eluxadoline ?

Answer 31

alcohol abuse and addiction liver diseases, Hx cholecystectomy

Question 32

Examples of a calcium channel blockers in the GI ?

Answer 32

pinaverium