GI: Functional GI disease and IBS Flashcards
What chronic GI symptoms are suggestive of a functional GI disorder?
- 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
What is globus?
Presistent intermittent sensation of a lump/foreign body in the throat
What is functional dyspepsia?
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.
Causes of functional dyspepsia
Diet
Acid
Duodenal sensitivity
Brain pain modulating circuits
Anxiety/depression
Differential dyspepsia
Reflux/GORD
Low grade duodenal ulcer
Delayed gastric emptying
IBS
Gastric/oesophageal cancer
What are the two subgroups of functional dyspepsia?
- Epigastric pain syndrome
- Post-prandial distress syndrome
What investigations would you want to consider doing in someone with features of functional dyspepsia?
Tests to exclude H. pylori
Endoscopy if ALARM symptoms
How would you manage functional dyspepsia?
- Placebo therapy
- Psychotherapy
- Dietary advice - reduce fat, caffeine, alcohol, cigarette smoking
- Consider SSRI’s
-
Management of symtpoms
- PPI
- Prokinetics
- Eradiation therapy
Consider differentials for nausea and vomiting
Immediate - psychogenic
>1 hour - pyloric obstruction, motility disorder
12 hours - obstruction
Aetiology:
- Drugs
- Alcohol
- Pregnancy
- Migraines
- Cyclical vomiting syndrome
Whats psychogenic vomiting
- Often occurs in young women
- Often for years
- May have no preceding nausea
- Appetite not usually disturbed but may lose weight
- Self-induce bulimia
What is IBS?
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
“Disorders of enhanced visceral perception (bowel symptoms for which no organic cause can be found)
What is the average age of onset of IBS?
<40 yrs
Which sex is IBS most common in?
Females
What are the different subtypes of IBS based on stool pattern?
- IBS with constipation
- IBS with diarrhoea
- Mixed IBS
- Unsubtyped
What type of diagnosis is IBS?
Diagnosis of exclusion
What are features of IBS?
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
What is the ROME criteria?
Used for diagnosis of IBS.
Positive diagnosis if:
3months of abdopain that is releived by defication, associated with change inf requency, cahnge in consistency
+
2 or more of: altered frequency, altered stool form, passage of mucus, bloating
What can symptoms of IBS be exacerbated by?
- Stress - incl depression, anxiety, other pscyhological problems and adverse life events
- Menstruation
- Gastroenteritis - and other post infectious
- Diet - alcohol, fizzy drinks, chocolate, caffeine drinks, fatty foods
What are signs may be present in someone with IBS?
Examination often normal, but may have
- Abdo tenderness
- Insufflation with air during endoscopy may ilicit symptoms
- Change in bowel habit
What would be red flag symptoms in someone with suspected IBS?
- Age > 60
- History <6 months
- Anorexia
- DEcreased weight
- Waking at night with pain/diarrhoea
- Mouth ulcers
- Abnormal CRP/ESR
Investigations in an IBS like presentation
FBC
TFT
Coeliac antibodies
Inflammatory markers (ESR)
Malabsorption screen
Stool culture
Colonscopy if >60 years
What is important to exclude as a diagnosis in females presenting with features of IBS?
- Ovarian cancer - serum CA-125
- Endometriosis
What are the genera approaches to management of IBS?
- Lifestyle modification
- Symptom management
- Cognitive therapy
How would you manage someone with constipation dominant IBS?
- Ensure adequate water and fibre intake
- Promote physical activity
-
Simple laxatives
- osmotic - lactulose, movicol
- stimulant - senna, bisacodyl
How would you manage Diarrhoea predominant IBS?
- Avoid sorbitol sweetners, alcohol and caffeine
- Reduce dietary fibre
- Encourage to identify trigger foods
- Consider bulking agents +/- loperamide
How would you manage Colic/bloating symptoms in IBS?
- Oral anti-spasmodics - mebeverine/hyoscine butylbromide
- FODMAP diet
What is the fodmap diet?
Elimination diet used to try to elminate fermentable oligo-, di-, mono-saccharides and polyols from the diet which are thought to cause IBS symptoms
How would you manage the psychological side to IBS?
- Consider CBT, hypnosis
- Consider SSRIs - amitryptilline
