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
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
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
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
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
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
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
8
Q
What is second-line pharmacological treatment?
A
- Low-dose tricyclic antidepressants (eg. amitriptyline 5-10mg)
- Used in preference to SSRIs
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
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