Functional bowel disorders

Question 1

Describe the clinical features of irritable bowel syndrome

Answer 1

Abdominal pain
Altered bowel habit
Abdominal bloating
Belching, wind, flatus
Mucus in stool
Symptoms rarely occur at night

Question 2

Describe the character of abdominal pain present in irritable bowel syndrome

Answer 2

Very variable
Often vague
May be burning or sharp
May radiate to lower back

Question 3

Describe the management of irritable bowel syndrome

Answer 3

Mainly: firm diagnosis, education, reassurance
Dietetic review
Drug therapy for pain, bloating, constipation, diarrhoea
Psychological interventions

Question 4

Which drugs might be used in the management of abdominal pain/bloating in irritable bowel syndrome?

Answer 4

For pain:
 - antispasmodics
 - linaclotide
 - antidepressants (TCAs, SSRIs)
For bloating:
 - some probiotics
 - linaclotide
 - avoid bulking agents/fibre

Question 5

Which drugs might be used in the management of constipation/diarrhoea in irritable bowel syndrome?

Answer 5

For constipation:
 - bulking agents/fibre
 - softeners, stimulants, osmotics
 - linaclotide
 - avoid TCAs
For diarrhoea:
 - antimotility agents
 - avoid SSRIs
 - diet

Question 6

What psychological interventions might be useful in managing irritable bowel syndrome?

Answer 6

Relaxation training
Hypnotherapy
Cognitive behavioural therapy
Psychodynamic interpersonal therapy

Question 7

Describe the possible causes of irritable bowel syndrome

Answer 7

brain “hearing” messages too loudly
heightened gut awareness
chronic stress response
possibly triggered by GI infection

Question 8

Give some examples of functional bowel disorders

Answer 8

Oesophageal spasm
Non-ulcer dyspepsia
Biliary dyskinesia
Irritable bowel syndrome
Slow transit constipation
Drug-related effects
Vomiting and nausea
 - (cyclical vomiting)