4) IBS Flashcards
What is IBS?
Disorders of enhanced visceral perception- Bowel symptoms for which no organic cause can be found
What are the ROME Criteria for diagnosis of IBS?
Abdo discomfort / pain for ≥ 12wks which has 2 of:
- Relieved by defecation
- Change in stool frequency (D or C)
- Change in stool form: pellets, mucus
+ 2 of:
- Urgency
- Incomplete evacuation
- Abdo bloating / distension
- Mucous PR
- Worsening symptoms after food
Other features such as lethargy, nausea, backache and bladder symptoms are common in people with IBS, and may be used to support the diagnosis
What are the exclusion criteria for IBS?
>40yrs Bloody stool Anorexia Wt. loss Diarrhoea at night
What Ix should be carried out in suspected IBS?
Bloods:
FBC, ESR, LFT, coeliac serology (EMa/TTG), TSH
Colonoscopy:
if >60yrs or any features of organic
disease
how can IBS be managed?
Exclusion diets can be tried
Bulking agents for constipation and diarrhoea (e.g.
fybogel).
Antispasmodics for colic/bloating (e.g. mebeverine)
Amitriptyline may be helpful
CBT
What are red flag symptoms when suspecting IBS?
unintentional and unexplained weight loss
rectal bleeding
a family history of bowel or ovarian cancer
a change in bowel habit to looser and/or more frequent stools persisting for more than 6 weeks in a person aged over 60 years.
What are red flag findings on examination for IBS?
anaemia
abdominal masses
rectal masses
inflammatory markers for inflammatory bowel disease.
Measure serum CA125 in primary care in women with symptoms that suggest ovarian cancer
What dietary advice can be given in IBS?
Have regular meals and take time to eat.
Avoid missing meals or leaving long gaps between eating.
Drink at least 8 cups of fluid per day,
Restrict tea and coffee to 3 cups per day.
Reduce intake of alcohol and fizzy drinks.
It may be helpful to limit intake of high‑fibre food
Reduce intake of ‘resistant starch’ often found in processed or re‑cooked foods.
Limit fresh fruit to 3 portions per day
People with diarrhoea should avoid sorbitol,
People with wind and bloating may find it helpful to eat oats
What medical therapy can be given for those with IBS?
- Antispasmodics
- Laxatives (but avoid lactulose)
- Consider linaclotide for people with IBS only if:
optimal or maximum tolerated doses of previous laxatives from different classes have not helped and
they have had constipation for at least 12 months.
-Loperamide should be the first choice of antimotility agent for diarrhoea in people with IBS
The dose should be titrated according to stool consistency, with the aim of achieving a soft, well‑formed stool (corresponding to Bristol Stool Form Scale type 4)
What can be used if first line medical treatments fail?
- 2) Low dose TCAs
3) SSRIs
