Ch 2.7 IBS

Question 1

What is Irritable Bowel Syndrome?

Answer 1

IBS is a functional bowel disorder in which abdominal pain is associated with defecation or change in bowel habit, with the additional features of disordered defecation and abdominal distension.

Question 2

What are the key 3 symptoms of IBS?

Answer 2

1. Abdominal pain - often central or left sided and can be severe
2. Bloating
3. Bowel habit - Diarrhoea and constipation may occur

Question 3

What are some aggravating factors of IBS? (4)

Answer 3

1. Stress- can precipitate & exacerbate symptoms
2. Caffeine - worsen symptoms
3. Sweeteners - Sorbitol and Fructose
4. Foods - milk/dairy products, chocolate, onion, garlic, chives

Question 4

What are the referral points for IBS? (8)

Answer 4

1. Children
2. Older person with no previous history of IBS
3. Pregnant women
4. Blood in stools
5. Unexplained weight loss
6. Caution in patients aged over 45 with changed bowel habit
7. Signs of bowel obstruction
8. Unresponsive to appropriate treatment

Question 5

What are the treatment options for IBS? (3)

Answer 5

1. Antispasmodics
2. Bulking Agents
3. Anti-diarrhoeals

Question 6

What are some examples of antispasmodics? (3)

Answer 6

1. Alvertine citrate
2. Peppermint Oil
3. Mebeverine

Question 7

How do antispasmodics work?

Answer 7

They have a direct effect on the smooth muscle of the gut, causing relaxation & reducing abdominal pain.

Question 8

What are the counselling points for Alvertine citrate?

Answer 8

Dose: 60-120mg up to TDS

Side Effects: rare but nausea, headache, rash

NOT recommended to pregnant or breastfeeding women or for children

Question 9

What are the counselling points of peppermint oil?

Answer 9

Capsules contain 0.2ml of oil - 1 or 2 caps taken TDS, 15-30min before meals.

Enteric coated (to reach the small bowel) - should not crush/chew = inactivate and can cause irritation of mouth.

Can cause heartburn - so avoid in those who suffer from it

Allergic reactions are rare - rash, headache and muscle tremor reported

Question 10

What are the counselling points of mebeverine hydrochloride?

Answer 10

Dose: 135mg TDS

Not recommended for pregnant/breastfeeding, children under 10 or those with porphyria.

Question 11

Name an example of a bulking agent and an antidiarrhoeal

Answer 11

Ispaghula husk

Loperamide

Question 12

What are some non-pharmacological advice can be given for IBS? (2)

Answer 12

1. Diet - low fat, low sugar, high fibre
   Avoiding the aggravating factors (sorbitol, fructose, caffiene)
2. Relaxation therapy - hypnotherpy, acupuncture, aromatherapy