IBS Flashcards
What is IBS?
A function bowel disorder - no identifiable organic disease underlying symptoms. Symptoms are a result of abnormal functioning of a otherwise normal bowel.
How do you diagnose?
Diagnosis of exclusion
% population affected?
10-20%
Symptoms suggesting IBS (NICE guidelines)?
- Abdo discomfort/pain relieved on defecation OR assoc. with change in bowel habits (form, frequency)
- AND 2 of:
- -> altered passage (straining vs. urgency)
- -> Bloating
- -> Worse eating
- -> passage of mucus
Pathology to exclude (NICE guidelines)?
1) Normal FBC, ESR + CRP
2) Negative faecal calprotectin - excludes IBD
3) Negative coeliac screen (anti-TTG)
4) cancer not suspected OR excluded if suspected
General management?
Advise there is no serious pathology:
- adequate fluids
- regular, small meals
- avoid processed food
- avoid caffeine + alcohol
- low FODMAP
- trial of probiotic supplements for 4 wks
- CBT
1st line medication for:
a) diarrhoea
b) constipation
c) cramps
a) loperamide
b) laxatives - AVOID lactulose
c) hyoscine butylbromide (Buscopan)
Medication if first line laxatives dont help constipation?
Linaclotide
Second line medication?
Tricyclic antidepressant –> Amitriptyline 5-10mg at night
3rd line medication?
SSRIs
Symptoms that may indicate organic disease?
1) pain disturbs sleep
2) diarrhoea disturbs sleep
3) fever
4) PR bleed
5) weight loss