Functional GI disease and IBS

Question 1

What chronic GI symptoms are suggestive of a functional GI disorder?

Answer 1

• Nausea alone
• Vomiting alone
• Belching
• Chest pain unrelated to exercise
• Postprandial fullness
• Abdominal bloating
• Abdo discomfort/pain
• Passage of mucus per rectum
• Frequent bowel movements with urgency first thing in the morning

Question 2

What is globus?

Answer 2

Presistent intermittent sensation of a lump/foreign body in the throat

Question 3

What is functional dyspepsia?

Answer 3

This is the second most common functional gastrointestinal disorder (after irritable bowel syndrome). Patients can present with a spectrum of symptoms including upper abdominal pain/discomfort, fullness, early satiety, bloating and nausea.

Question 4

What are the two subgroups of functional dyspepsia?

Answer 4

• Epigastric pain syndrome
• Post-prandial distress syndrome

Question 5

What investigations would you want to consider doing in someone with features of functional dyspepsia?

Answer 5

Tests to exclude H. pylori

Question 6

How would you manage functional dyspepsia?

Answer 6

• Placebo therapy
• Psychotherapy
• Dietary advice - reduce fat, caffeine, alcohol, cigarette smoking
• Consider SSRI’s

Question 7

What is IBS?

Answer 7

A mixed group of abdominal symptoms for which no orgnaic cause can be found. Most are probably due to disorders of intestinal motility, enhanced visceral perception or microbial dysbiosis

Question 8

What is the average age of onset of IBS?

Answer 8

<40 yrs

Question 9

Which sex is IBS most common in?

Answer 9

Females

Question 10

What are the different subtypes of IBS based on stool pattern?

Answer 10

• IBS with constipation
• IBS with diarrhoea
• Mixed IBS
• Unsubtyped

Question 11

What type of diagnosis is IBS?

Answer 11

Diagnosis of exclusion

Question 12

What are features of IBS?

Answer 12

Chronic, recurrent abdominal discomfort associated with at least 2 of:

• Relief by defecation
• Altered stool form
• Altered bowel frequency
• Urgency
• Incomplete evacuation
• Abdominal bloating
• Mucus PR
• Worsening symptoms after food

Question 13

What can symptoms of IBS be exacerbated by?

Answer 13

• Stress
• Menstruation
• Gastroenteritis

Question 14

What are signs may be present in someone with IBS?

Answer 14

Examination often normal, but may have

• Abdo tenderness
• Insufflation with air during endoscopy may ilicit symptoms

Question 15

What would be red flag symptoms in someone with suspected IBS?

Answer 15

• Age > 60
• History <6 months
• Anorexia
• DEcreased weight
• Waking at night with pain/diarrhoea
• Mouth ulcers
• Abnormal CRP/ESR

Question 16

What is important to exclude as a diagnosis in females presenting with features of IBS?

Answer 16

• Ovarian cancer - serum CA-125
• Endometriosis

Question 17

What are the genera approaches to management of IBS?

Answer 17

• Lifestyle modification
• Symptom management
• Cognitive therapy

Question 18

How would you manage someone with constipation dominant IBS?

Answer 18

• Ensure adequate water and fibre intake
• Promote physical activity
• Simple laxatives

Question 19

How would you manage Diarrhoea predominant IBS?

Answer 19

• Avoid sorbitol sweetners, alcohol and caffeine
• Reduce dietary fibre
• Encourage to identify trigger foods
• Consider bulking agents +/- loperamide

Question 20

How would you manage Colic/bloating symptoms in IBS?

Answer 20

• Oral anti-spasmodics - mebeverine/hyoscine butylbromide
• FODMAP diet

Question 21

What is the fodmap diet?

Answer 21

Elimination diet used to try to elminate fermentable oligo-, di-, mono-saccharides and polyols from the diet which are thought to cause IBS symptoms

Question 22

How would you manage the psychological side to IBS?

Answer 22

• Consider CBT, hypnosis
• Consider SSRIs - amitryptilline