Functional dyspepsia & irritable bowel syndrome (IBS)

Question 1

Define irritable bowel syndrome (IBS)

+4

Answer 1

A function bowel disorder - Recurrent episodes of abdominal pain/discomfort (in absence of detectable organic pathology) for >6 months of previous year, associated with 2 of:

Altered stool passage
Abdominal bloating
Symptoms made worse by eating
Passage of mucus

Question 2

Aetiology of IBS

2

Answer 2

UNKNOWN
Could be visceral sensory abnormalities, gut motility abnormalities, psychosocial factors (e.g. stress) or food intolerance (e.g. lactose)

Question 3

Epidemiology of IBS (prevalence x2, gender)

Answer 3

COMMON
10-20% adults
More common in females (2:1)

Question 4

Presenting symptoms of IBS

6

Answer 4

6+ months history of abdominal pain
often colicky
in lower abdomen
relieved by defecation or passing of flatus
Altered bowel frequency  (>3 motions per day or <3 per week)
Abdominal bloating
Change in stool consistency
Passage w/ urgency or straining 
Tenesmus

Question 5

Red flag symptoms to screen for

4

Answer 5

(To exclude malignancy)
Weight loss
Anaemia
PR bleeding 
Late onset (>60 yrs)

Question 6

Signs of IBS on physical examination

2

Answer 6

Usually NORMAL

Sometimes abdomen may appear distended & be mildly tender on palpation in 1/both iliac fossae

Question 7

Investigations for IBS

general +5

Answer 7

Diagnosis mainly from history but organic pathology must be excluded

Bloods
Stool exam
US
Urease breath test
Endoscopy

Question 8

Investigations for IBS - bloods

6

Answer 8

FBC (anaemia)
LFT
ESR
CRP
TFT
Anti-endomysial/anti-transglutaminase antibodies (coeliac)

Question 9

Investigations for IBS - stool examination

Answer 9

Microscopy & culture for infective cause

Question 10

Investigations for IBS - US

Answer 10

Exclude gallstone disease

Question 11

Investigations for IBS - urease breath test

Answer 11

Exclude dyspepsia due to H pylori

Question 12

Investigations for IBS - endoscopy

Answer 12

If other pathologies suspected

Question 13

Management of IBS

3 categories

Answer 13

Advice
Medical
Psychological therapy

Question 14

Management of IBS - advice

Answer 14

Dietary modification

Question 15

Management of IBS - medical

5

Answer 15

Depends on main symptoms
Antispasmodics (e.g. buscopan)
Prokinetic agents (e.g. domperidone, metaclopramide)
Anti-diarrhoeals (e.g. loperamide)
Laxatives (e.g. senna, movicol, lactulose)
Low-dose tricyclic antidepressants (may reduce visceral awareness)

Question 16

Management of IBS - psychological

2

Answer 16

CBT

Relaxation & psychotherapy

Question 17

Complications of IBS

2

Answer 17

Physical & psychological mobility

Increased incidence of colonic diverticulosis

Question 18

Prognosis of IBS

2

Answer 18

Chronic relapsing & remitting course of disease

Often exacerbated by psychosocial stresses