0318 - IBS and IBD

Question 1

What is a typical presentation of IBS

Answer 1

Change in stool form and frequency (diarrhoea or constipation) associated with abdominal pain, disturbed defaecation, and bloating. Symptoms relieved by defaecation.

Question 2

What are the Rome III Criteria for diagnosis of IBS?

Answer 2

3 d/m, >3months

Relieved by defaecation

Associated with a change in stool form and frequency

Question 3

What is a strategy for investigation and treatment of IBS

Answer 3

First rule out anything sinister (FBC, UEC, LFT, coeliac, infection)

Then colonoscopy.

Question 4

How can you manage IBS?

Answer 4

Good therapeutic relationship, based on empowering patient.

Dietary therapy - FODMAP diet and raise fibre levels

Psychological therapy

Pro/antibiotics

Loperamide for diarrhoea

Question 5

What does FODMAP stand for?

Answer 5

Fermentable Oligo-Di-Monosaccharides-And-Polyols

Question 6

Understand the presentation and clinical features of IBD

Answer 6

How does UC typically present?

Proctitis - Urgency, persistent bleeding, discomfort, diarrhoea or constipation.
Symptoms get worse as disease extends proximally.

Question 7

What are some typical investigations for UC?

Answer 7

FBC (due to bleeding), UEC, LFT.

Colonoscopy will show erythema, loss of normal vascular pattern, contact bleeding and mucopus or blood. - Irritated all over.

Severe disease will have extensive ulceration and pseudopolyp formation.

Question 8

What is a typical presentation of Crohn’s disease

Answer 8

Relapsing and remitting diarrhoea, abdominal pain and weight loss.

Systemic symptoms - Fevers, anorexia, lethargy and malaise.

Affects any part of GIT, but perianal symptoms are common.
If in Left colon, may be similar presentation to UC.

Question 9

How is Crohn’s disease diagnosed?

Answer 9

Typically via (ileo)colonoscopy which will show extensive ulceration.

Question 10

What is the typical treatment for Crohn’s diseae?

Answer 10

Steroids, together with immunosuppressives and infliximab (anti-TNF)

Question 11

What are some major differences between Crohn’s and UC?

Answer 11

Crohn’s can appear anywhere in GIT, UC exclusive to colon and rectum

Crohn’s frequently hits perianal area, UC rarely (it’s not the colon)

Crohn’s is full-thickness of bowel wall, UC is only in epithelial

Crohn’s is mediated by macrophages, UC by plasma cells (humoral)

Question 12

What is the typical treatment for severe UC

Answer 12

Infliximab

Surgery (colectomy) if refractory to drugs.