7.3 IBS and IBD

Question 1

Who usually gets IBS?

Answer 1

Females, 25-44

Question 2

What is the ROME III classifications of IBS?

Answer 2

3 months or more
Abdominal discomfort/pain at least 3d/month
Relieved by defecation
Associated with a change in stool appearance or form and frequency

Question 3

What are the new onset alarm symptoms of IBS?

Answer 3

> 40
GI bleeding
Weight loss or other evidence of malnutrition
Fever
Significant family history of GI disease
O/E abdominal mass or abnormality
Anaemia, blood test abnormalities

Question 4

What are the symptoms of IBS?

Answer 4

Abnormal frequency (>3/day <3/week) 
Abnormal stool form 
Abnormal passage 
Passage of mucus 
bloating

Question 5

What are the management options for IBS?

Answer 5

Patient based groups 
Dietary therapy: food diary, dietician, FODMAP exclusion, high fibre 
Psychological therapy 
Loperamide for diarrhoea 
Probiotics or antibiotics

Question 6

What is FODMOAPS and what is the purpose

Answer 6

Fermentable Oligo-, Di-, Mono-saccharides And Polyols
Aim is to reduce the distension of the small and large intestine that these molecules can cause thus reducing the pain and bloating associated with functional gastrointestinal disorder

Question 7

What are the genetic components of Chron’s and UC?

Answer 7

Chrons: over 70 genetic loci identified
UC: weaker association

Question 8

What is the distribution of chrons and UC?

Answer 8

Chrons: Anywhere along the GIT
UC: colon and continuous

Question 9

Do you see perianal disease in Chron’s and UC?

Answer 9

Yes in Chon’s

Question 10

What is the pathology of chrons and UC?

Answer 10

Chrons: full thickness of bowel wall, macrophages and granulomata

UC: superficial (epithelium) and plasma cells

Question 11

What is the presentation of ulcerative colitis?

Answer 11

Proctitis: urgency, bleeding, discomfort

diarrhoea mixed with blood and mucus

Question 12

What are the symptoms and signs of severe UC?

Answer 12

>6 bloody stools/day 
Fever 
Tachycardia 
Anaemia 
Leucocytosis 
Elevated ESR 
Hypoalbuminaemia

Question 13

What are the potential complications of UC?

Answer 13

Fulminant colitis 
Toxic megacolon 
Perforation 
Peritonitis 
Haemorrhage  
Dysplasia and cancer

Question 14

What is the current treatment options for UC?

Answer 14

5-asa: Sulfasalazine 
Steroids: Prednisolone 
Immunosuppressive AZA/6-MP: Azathioprine 
Monoclonal antibodies: Infliximab 
Surgery

Question 15

What is the mechanism for sulfaslazine (5-ASA drugs)

Answer 15

In Crohn’s disease and ulcerative colitis, it is thought to be an antinflammatory drug that provides topical relief inside the intestine. It does this via a number of mechanisms such as reducing the synthesis of inflammatory mediators known as eicosanoids and inflammatory cytokines

Question 16

What are the adverse effects of glucocorticoids?

Answer 16

Psychological and sleep disturbances 
Weight gain and redistribution of fat 
dermatological effects 
metabolic effects (diabetes, hypertriglycerideaemia) 
Osteoporosis  
GI effects (dyspepsia, peptic ulceration) 
Hypertension 
Oedema

Question 17

What are the surgery options for UC?

Answer 17

Colectomy: two stage procedure of formation of an ileal pouch-anal anastamoses

J pouch for younger people who don’t want a bag

Question 18

What is the presentation of chrons?

Answer 18

diarrhoea, abdominal pain, weight loss

Question 19

What are the symptoms and signs of chrons?

Answer 19

Systemic symptoms often present: fever, anorexia, lethargy, malaise
perianal complications: anal fissures, abscesses, fistulae

Question 20

What are the extra-intestinal manifestations of chrons?

Answer 20

Skin: erythema nodosum, pyoderma gangrenosum, aphthous stomatitis

Joints: acute self limiting inflammation, chronic arthritis, sacro-iletis

Eyes: iritis, uveitis, episcleritis

Liver: primary sclerosing cholangitis

Question 21

What is the treatments of chrons?

Answer 21

Prednisolone/Budesondie and AZA/6-MP
or
Anti-TNF and AZA