1.5.2 Nutrition and Common GI Disorders

Question 1

What are the two types of fiber and their characteristics?

Answer 1

Insoluble: the scrub brush

Soluble: the sponge (more beneficial)

Question 2

What are some of the possible pathophysiogolgy explanations of IBS?

Answer 2

Altered response to normal environmental stimuli

Abnormal GI neurotransmitter/receptor/activity

Hightened sensation of pain

Abnormality of motility

Intestinal inflammation

Post-infectious

Psychosocial dysfunction

Bacterial

Genetic Predisposition

Dietary intolerance

Question 3

What are some dietary factors that should be taken into consideration with IBS-D and IBS-M

Answer 3

High fat meals poorly tolerated

Large meals poorly tolerated

Reduce lactose

Low food sources of FODMAP

Coffee can be poorly tolerated

Alcoholic beverages can be poorly tolerated

Use of probiotics

Dietary fiber

Question 4

What is the definition of IBS (Rome IV Criteria)?

Answer 4

A recurrent abdominal pain, on average, at least 1 day/week in the last three months, associated w/ 2 or more of the following criteria:

Related to defecation

Associated with a change in stool frequency

Associated with a change in stool form

Question 5

What are the 4 subtypes of IBS?

Answer 5

IBS-C: Constipation predominant

IBS-D: Diarrhea predominant

IBS-M: Mixed

IBS-U: Unspecified

Question 6

What does FODMAP stand for?

Answer 6

These are all poorly absorbed carbohydrates that should be restricted in IBS-D

Fermentable

Oligo

Di

Monosaccharides

And

Polyols

Question 7

What are some of the potential GI applications for working with gut microbiota?

Answer 7

Forms of diarrhea

IBS

Liver Dz

SIBO

Question 8

What proportion of IBS patients suffer from IBS-C? IBS-D?

Answer 8

IBS-C - 25%

IBS-D - 15-45%

Question 9

What are some important dietary factors to consider for IBS-C?

Answer 9

Adequate but not excessive fiber (mixture of soluble and insoluble fiber)

Adequate fluids

Adequate exercise

Question 10

What are three types of symptoms associated with food allergies?

Answer 10

GI, Cutaneous, Respiratory

Question 11

What should be increased with increased fiber?

Answer 11

Water intake

Question 12

What type of meals typically worsen the exaggerated gastrocolic reflex?

Answer 12

Large meals high in fat

Question 13

What are the three approaches to treating IBS?

Answer 13

Diet, medications, and psychobehavioral

Question 14

Immune-mediated response to food, presents with gastrointestinal symptoms

Answer 14

Food allergy

Question 15

What are some of the alarming presentations that should not be associated with IBS?

Answer 15

Weight loss, rectal bleeding, anemia, and should not be nocturnal or progressive

Question 16

What is one of the hallmark features of IBS-D?

Answer 16

Exaggerated gastrocolic reflex (w/in 15 minutes (or 3 hrs) of eating)

Question 17

What she got, Doc?

Answer 17

IBS-D

Question 18

What is the common reason for a referral from a PCP to a gastroenterologist?

Answer 18

IBS (20-50% of all referrals)

Question 19

What % of medical students suffer from IBS?

Answer 19

22%

Question 20

What are some of the necessary rule outs when diagnosing IBS-D?

Answer 20

Celiac dz, disaccharides deficiencies, food allergies, gluten intolerance, colitis, bile acid malabsorption, SIBO

Question 21

What is the “food cripple” cycles?

Answer 21

1. Symptoms attributed to foods, types
2. Avoidance of food and food groups
3. Axienty, intolerance, and anticipation with foods
4. Anxiety leads to symptoms of IBS
5. Misinformation, lack of understanding

Question 22

What are some of the food that have FODMAP components?

Answer 22

wheat, rye, onions, garlic, legumes, milk, honey, apples, pears, watermelon, mango, peaches, sugar free items, mushrooms, cauliflower

Question 23

In IBS-D…

Answer 23

Alarm symptoms

Male

Recent use of antibiotics

Over 50

Question 24

What are some ways to slow colonic transit in IBS-C?

Answer 24

Secretagogues or prokinetic agents

Exercise

Question 25

What are the big 8 of food allergies (in US)?

Answer 25

milk, eggs, peanuts, tree nuts, soy, fish, shellfish, wheat

(This list varies in other countries)

Question 26

In the case of IBS-D…

Answer 26

Rome IV Criteria, a diagnosis of exclusion

Question 27

In IBS-D, what dietary interventions are available?

Answer 27

limit fat consumption, small and more frequent meals, increase fiber, low FODMAP foods, limit specific foods

Question 28

What demographic is more commonly diagnosed with IBS?

Answer 28

Women; Younger patients

Question 29

What % of people suffer from a lactase deficiency?

Answer 29

70%