Functional GI Disorders Flashcards

1
Q

What is IBS?

A
  • Denotes a mixed group of abdominal symptoms for which no organic cause can be found
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2
Q

What features are required for a positive diagnosis of IBS?

A
  • Abdo pain relieved by defacation or associated with altered bowel frequency stool form, in addition to 2/4 of:
    • altered stool passage (straining, urgency, incomplete evacuation)
    • abdo bloating, distension, tension or hardness
    • symptoms made worse by eating
    • passage of mucus
  • Lethargy, nausea, backache and bladder symptoms also support diagnosis
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3
Q

Which red flag features should be enquired about?

A
  • Rectal bleeding
  • Unexplained weight loss
  • FHx of bowel or ovarian cancer
  • Onset after 60 yrs of age
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4
Q

Which investigations should be carried out?

A
  • FBC, ESR, CRP + coeliac serology
  • If >60yrs or any organic marker of idsease (blood PR, weight loss) → colonoscopy
  • In females, exclude ovarian cancer (CA-125) + endometriosis often mimics IBS
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5
Q

The management of irritable bowel syndrome (IBS) is often difficult and varies considerably between patients. Which 3 elements constitute management?

A
  • Diet
  • Psychological
  • Pharmacological
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6
Q

What are first-line pharmacological treatments, according to predominant symptoms?

A
  • Pain → antispasmodics (eg. buscopan / hyoscine butylbromide)
  • Constipation → laxatives but avoid lactulose
  • Diarrhoea → loperamide 2mg
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7
Q

What should be done for patients with constipation who are not responding to conventional laxatives?

A
  • Linaclotide, if:
    • optimal or max tolerated doses of prev laxatives from diff classes not helped AND
    • they have had constipation for at least 12 months
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8
Q

What is second-line pharmacological treatment?

A
  • Low-dose tricyclic antidepressants (eg. amitriptyline 5-10mg)
  • Used in preference to SSRIs
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9
Q

What other psychological interventions can help IBS?

A
  • If symptoms don’t respond to pharm treatments after 12 months and who develop continuing symptom profile (refractory IBS), consider referring for:
    • cognitive behavioural therapy
    • hypnotherapy
    • psychological therapy
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10
Q

What is the general dietary advice for IBS?

A
  • Have regular meals and take time to eat
  • Avoid missing meals or leaving long gaps
  • Drink 8 cups of fluid/day, esp water and herbal teas
  • Restrict tea and coffee → max 3 cups/day
  • Reduce intake of alcohol + fizzy drinks
  • Consider limiting intake of high-fibre food
  • Reduce intake of resistant starch (processed foods)
  • Limit fresh fruit to 3 portions/day
  • For diarrhoea, avoid sorbitol
  • Wind + bloating → increase oats (cereal, porridge) + linseeds
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