Functional Gut Disorders

Question 1

what is the Rome III diagnostic criteria for Irritable Bowel Syndrome?

Answer 1

• recurrent abdominal pain or discomfort at least 3 days in the last 3 months associated with 2 or more of the following:
  (i) improvement with defecation
  (ii) onset associated with a change in frequency of stool
  (iii) onset associated with a change in form of stool

Question 2

what is the Manning diagnostic criteria for IBS?

Answer 2

• pain relieved with defecation
• more frequent stools at the onset of pain
• looser stools at the onset of pain
• visible abdominal distension
• passage of mucus
• sensation of incomplete evacuation

Question 3

what investigations would you do when diagnosing IBS?

Answer 3

• PV/CRP
• AXR
  _ endoscopic/histopathological colonic evaluation
• X-sectional imaging
• H+ breath test
• 14C-glycocholic acid breath test/SeHCAT test
• faecal eastatse/’trial of creon’
• gut hormones

Question 4

what is 14C-glycocholic acid breath test/SeHCAT test?

Answer 4

measures (decreased) absorption of bile acid and bacterial overgrowth at the same time. The SeHCAT test measures bile acid absorption only and is therefore is more specific for that indication

Question 5

what does a positive H+ breath test show?

Answer 5

bacteria in the small intestine

Question 6

what diet should a patient with IBS-C (constipation) follow?

Answer 6

• maintain healthy intake of fruit and vegetable
• increase carefully
• seeds and skins may irritate symptoms
• some foods may ferment leading to gas/bloating

Question 7

should antispasmodics be used in IBS? why?

Answer 7

• may not work well - decrese motility
• short/medium term relief of pain
• eventually refractory

Question 8

name some examples of antispasmodics?

Answer 8

• mebeverine (colfac)
• alverine citrate (spasmonal)
• peppermint oil (colpermin)

Question 9

is fibre good for IBS-C?

Answer 9

‘bran’ fibre is ineffective nut soluble fibre supplements are effective (ispaghula, psyllium)

Question 10

what do osmotic laxatives do and give some examples

Answer 10

• less bloating
• improves constipation
• eg NaHCO3, NaCl, KCl, lactulose, milk of magnesia

Question 11

what is a granylate cyclase agonist?

Answer 11

linaclotide (Constella)

• peptide agonist of granylate cyclase 2C
• increases intracellular cyclic GMP
• increased intestinal secretion and transit
• reduces abdominal pain

Question 12

what are selective C-2 chloride channel activators?

Answer 12

Lubiprostone

• placebo
• bucyclic fatty acid derived from prostoglandin E
• soften stool, increases mobility

Question 13

what diet should a patient with IBS-D follow?

Answer 13

• limit fruit
• avoid pith/skins
• more veg
• reduce bran fibre

Question 14

name 2 anti-diarrhoeals and what they do

Answer 14

Loperamide
- reduces stool frequency 
- improves consistency 
Codeine Phosphate
- effective
- should be avoided