Functional Dyspepsia & Irritable Bowel syndrome (IBS)

Question 1

Define Functional Dyspepsia + Irritable Bowel syndrome (IBS)

Answer 1

Chronic condition characterised by recurrent episodes of abdominal pain/discomfort for >6 months of the previous year, in the absence of detectable organic pathology, associated with 2 of the following:
Altered stool passage 
Abdominal bloating
Symptoms made worse by eating
Passage of mucus

Question 2

Aetiology of Functional Dyspepsia + Irritable Bowel syndrome (IBS)

Answer 2

Unknown

Dysfunction of motor and sensory aspect of the digestive tract
Altered gut reactivity to environmental or luminal stimuli

Question 3

Risk factors for Functional Dyspepsia + Irritable Bowel syndrome (IBS)

Answer 3

Age <50 
Females > males 
Stress
Family history 
Physical and sexual abuse 
PTSD
Previous gastroenteritis infection

Question 4

Symptoms of Functional Dyspepsia + Irritable Bowel syndrome (IBS)

Answer 4

Abdominal pain/discomfort (often lower abdomen | >6 months Hx | colicky pain | exacerbated by stress/food | relieved by defecation or flatus)
Change in stool consistency and frequency (≥ 3 daily OR ≤ 3 weekly)
Urgency
Straining
Tenesmus
Bloating
Mucus in stool

Question 5

Signs of Functional Dyspepsia + Irritable Bowel syndrome (IBS)

Answer 5

Normal abdominal exam

May have slightly distended abdomen or mild tenderness in one or both iliac fossa

Question 6

Investigations for Functional Dyspepsia + Irritable Bowel syndrome (IBS)

Answer 6

Diagnosis of Exclusion

Investigations should be normal:
Stool sample (infection)
Hydrogen breath test (H. pylori)

FBC (infection)
U+Es
ESR/CRP
TFTs (thyrotoxicosis)
Anti-endomysial Ab + Anti-tTG  (coeliac)

AXR
USS (gallstones)
Endoscopy

Question 7

Management for Functional Dyspepsia + Irritable Bowel syndrome (IBS)

Answer 7

Lifestyle modifications - diet => avoid caffeine, lactose, fructose | ADD fibre

Depends on symptoms:
Constipation -> laxative e.g. lactulose
Laxative intolerance -> lubiprostone or linaclotide
Diarrhoea -> antidiarrhoeals e.g. loperamide
Pain -> antispasmodics e.g. buscopan
Probiotics
Depression: SSRI, TCAs

Question 8

Complications of Functional Dyspepsia + Irritable Bowel syndrome (IBS)

Answer 8

Increased risk of colonic diverticulosis 
Damage to family and work relationships 
Depression
Sleep disorders
LRTI symptoms

Question 9

Prognosis for Functional Dyspepsia + Irritable Bowel syndrome (IBS)

Answer 9

Chronic relapsing and remitting course
Exacerbation by psychological stress
Normal life expectancy
No long-term complications