A3- Inflammatory Bowel Disease & Irritable Bowel Syndrome

Question 1

What are the several subtypes of IBS?

Answer 1

• IBS-A = alternating
• IBS-B = bloating
• IBS-C = constipation
• IBS-D = diarrhoea

Question 2

does IBS affect women more or men

Answer 2

women

•1 in 10 of population – globally

Question 3

What are the Two main subtypes of IBD

Answer 3

• Crohn’s disease - subtypes – ileocolonic, SB, colonic; varying patterns
• Ulcerative colitis – subtypes – (proctitis), left-sided, extensive (?pancolitis)

Question 4

Compare IBS CD and UC SYMPTOMS

Answer 4

Question 5

How do you differentiate between IBS vs IBD

Answer 5

Calprotectin

Question 6

if calprotectin is in the stool then the bowel is ?

Answer 6

inflamed

Question 7

Causes of IBS

Answer 7

• Family history often positive (? Shared environment vs shared genes)
• Diet (dysbiosis)
• Stress …
• Post-infection (dysbiosis) - ? up to 10%
• Antibiotics

Question 8

Differentials for IBS

Answer 8

•IBD
•Coeliac disease
•Watery diarrhoea – drug side effects, microscopic colitis, bile acid
diarrhoea
•Older people differential always includes colorectal cancer
•Does diverticulosis cause symptoms (debatable)

Question 9

What does IBS diagnosis consist of?

Answer 9

• History – easier in young patients
• Normal examination
• ? Normal calprotectin
• In ‘older patients (>45y?)’ consider investigation

Question 10

Treatment for IBS

Answer 10

Positive clinical diagnosis supported by negative calprotectin
•History – diet / stress / post-infection IBS
•Diet – advice / low FODMAPs
•Gluten -free, avoid milk, stone fruit, frutans
•Stress – talking therapies (CBT , mindfulness etc), SSRI/ tricyclics
•PI-IBS – supportive, symptomatic, diet

Question 12

What are the symptoms you find in ileal disease?

Answer 12

pain (RIF?), looser stools
•Pain is constant ache (inflammation) or colicky (narrowing / stenosis /
stricture)

Question 13

What are the symptoms you find in colonic disease?

Answer 13

diarrhoea, ? bleeding, ?? pain in LIF / lower

Question 14

What are the symptoms you find in perianal disease?

Answer 14

severe pain (abscess), later discharge (fistula) and
or bleeding (fissure)

Constitution symptoms – fatigue, weight loss, extra-intestinal
manifestations (ulcers, eyes, joints, rash)

Question 15

Crohn’s Disease: investigation

Answer 15

FBC / iron studies / B12, folate, vitamin D)
•CRP / LFTs
•Faecal calprotectin
•Colonoscopy
•Small bowel imaging (MR/ CT/ video capsule endoscopy (VCE))
•(Ultrasonography)
•(Serology)

Question 16

Complications of Crohns?

Answer 16

Stenosis

inflammation

distended lumen

Fistula

Question 17

UC

Younger or older

F/M

smoker or non smokers?

Answer 17

• Younger people
• F=M
• Non-smokers
• Family history
• Western life-style

Question 18

How do symptoms present in colonic disease and distal disease

Answer 18

• Colonic disease: diarrhoea, (?) bleeding
• Distal disease (proctitis): bleeding, constipation> diarrhoea

Constitution symptoms – fatigue, weight loss, extra-intestinal
manifestations (ulcers, red/painful eyes, joints ache,
erythema nodosum

Question 19

Where is the common location of UC

Answer 19

Question 20

Ulcerative colitis: investigation

Answer 20

• FBC / iron studies
• CRP / LFTs
• Faecal calprotectin
• Colonoscopy

Question 21

Inflammatory Bowel Disease: treatment

Ulcerative colitis: 5-ASA

Answer 21

• 5-aminosalicylic acid (aka mesalazine)
• Topically acting anti-inflammatory
• Oral – tablets / granules
• PR – suppositories / foam / enema
• Used to treat mild to moderate UC
• Used to maintain remission
• May reduce risk of colorectal cancer

Question 22

Ulcerative colitis: What steroids can you use?

Answer 22

Mild-moderate UC – oral – beclomethasone (Clipper) / budesonide –
fewer / milder systemic side effects
•Moderate to (Severe) UC - oral – Prednisolone 40mg od – taper over 8
weeks
•(with bone protection)
•‘Acute severe’ UC – IV -hydrocortisone
•(Enemas and suppositories also used)

Question 23

IBD immunosupression options?

Answer 23

•Azathioprine
•Mecaptopurine / allopurinol
•Methotrexate
•As steroid sparing, second line medication – with due attention to
safety, risks and monitoring
•Slow action
•Role in maintenance (?overshadowed by biologic agents)

Question 24

What are the IBS immunosupression risk

Answer 24

Question 25

Current biological agents used for IBD

Answer 25

Anti-TNFs (infliximab, adalimumab, golimumab) – for CD, UC
•Anti-a4b7 (vedolizumab) – for CD, UC

Question 26

Small oral inhibitors for IBD

Answer 26

JAK Stat pathway
•Tofacitanib -UC (CD)

Question 27

Surgery options for IBD

Answer 27

• Colectomy
• Local resection