Gastro - IBS Flashcards
What is IBS caused by?
Disturbance of gut-brain interaction causing troublesome abdominal and intestinal symptoms
What does it mean that irritable bowel syndrome is a functional disorder?
No identifiable bowel disease underlying the symptoms
Abnormal functioning of normal bowel
Who is affected by IBS?
20% of population
Women
Younger adults
What are the key features of IBS?
IBS
I- Intestinal discomfort
B- Bowel habit abnormalities
S- Stool abnormalities
What are some common symptoms of IBS?
Abdominal pain
Diarrhoea
Constipation
Fluctuating bowel habit
Bloating
Worse after eating
Improved by opening bowels
Passing mucus
What can IBS be triggered or worsened by?
Anxiety
Depression
Stress
Sleep
Illness
Medications
Caffeine
Alcohol
Certain foods
What are the most likely differentials when considering IBS?
Bowel cancer
IBD
Coeliac disease
Ovarian cancer (vague symptoms, bloating in women over 50)
Pancreatic cancer
How is IBS diagnosed?
Thorough history and examination
Exclusion of red flags and other underlying pathology
What investigations are used for IBS?
FBC (anaemia)
ESR
CRP
Coeliac serology (anti-TTG antibodies)
Faecal calprotectin (IBD)
CA125 (ovarian cancer)
What are the criteria for diagnosing IBS?
At least 6 months of abdominal pain or discomfort and one of :
- Pain or discomfort relieved by opening bowels
- Bowel habit abnormalities
- Stool abnormalities
And at least two of :
- Straining
- Bloating
- Worse after eating
- Passing mucus
How is IBS managed?
Lifestyle advice
- Drink enough fluids
- Regular small meals
- Fibre intake
- Limit caffeine
- Low FODMAP diet
- Probiotic supplements
- Reduce stress
- Regular exercise
First line medications
Loperamide (for diarrhoea)
Bulk-forming laxatives (ispaghula husk)
Antispasmodics (mebeverine, hyoscine butylbromide, peppermint oil)
Why is lactulose avoided?
Can cause bloating
What can be given for constipation in IBS if first-line laxatives are not adequate?
Linaclotide
What can be given if symptoms remain uncontrolled after management?
Low-dose tricyclic antidepressants (amitriptyline)
SSRI antidepressants
CBT
Specialist referral
