Functional Dyspepsia & Irritable Bowel Syndrome

Question 1

Definition

Answer 1

IBS - A functional bowel disorder defined as recurrent episodes of abdominal pain/discomfort (in the absence of detectable organic pathology) for > 6 months of the previous year, associated with two of the following:

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

Question 2

Aetiology

Answer 2

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

Question 3

Epidemiology

Answer 3

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

Question 4

Presenting symptoms

Answer 4

• 6+ months history of abdominal pain
o Pain is often colicky
o It is in the lower abdomen
o Relieved by defecation or passing of flatus

• Altered bowel frequency (> 3 motions per day or < 3 motions per week)
• Abdominal bloating
• Change in stool consistency
• Passage with urgency or straining
• Tenesmus (cramping rectal pain)

Blood in stool suggests it’s not likely to be IBS - more likely IBD

Question 5

Red flag symptoms

Answer 5

MAKE SURE YOU SCREEN FOR RED FLAG SYMPTOMS:

o Weight loss
o Anaemia
o PR bleeding
o Late onset (> 60 yrs)

o NOTE: if any of these are present then you must exclude colonic malignancy

Blood in stool makes it less likely to be IBS

Question 6

Signs on physical examination

Answer 6

• Usually NORMAL on examination

* Sometimes the abdomen may appear distended and be mildly tender on palpation in one or both iliac fossae

Question 7

Investigations

Answer 7

• Diagnosis is mainly from the history but organic pathology must be excluded
• Blood: FBC (anaemia), LFT, ESR, CRP, TFT, anti-endomysial/anti-tranglutaminase antibodies (coeliac disease)
• Stool examination: microscopy and culture for infective cause
• Ultrasound: exclude gallstone disease
• Urease breath test: exclude dyspepsia due to Helicobacter pylori
• Endoscopy: if other pathologies suspected

Question 8

Management plan

Answer 8

• Advice: dietary modification

• Medical: depends on the main symptoms affecting the patient
o Antispasmodics (e.g. buscopan)
o Prokinetic agents (e.g. domperidone, metaclopramide)
o Anti-diarrhoeals (e.g. loperamide)
o Laxatives (e.g. senna, movicol, lactulose)
o Low-dose tricyclic antidepressants (may reduce visceral awareness)

• Psychological therapy:
o CBT
o Relaxation and psychotherapy

Question 9

Possible complications

Answer 9

• Physical and psychological morbidity

* Increased incidence of colonic diverticulosis

Question 10

Prognosis

Answer 10

• Chronic relapsing and remitting course of disease

* Often exacerbated by psychosocial stresses