IBS

Question 1

Irritable bowel syndrome (IBS) is a common, chronic, relapsing, and often life-long condition, mainly affecting people aged between ____________ years. More common in ____________ (men/women)

Answer 1

20-30

Women

Question 2

Symptoms of IBS include …(4)

Answer 2

1. Abdominal pain or discomfort
2. Disordered defecation (either diarrhea, constipation with straining, urgency, incomplete evacuation)
3. Passage of mucus
4. Bloating

Question 3

Features of disordered defecation in IBS include… (4)

Answer 3

1. Diarrhea
2. Constipation with straining
3. Urgency
4. Incomplete evacuation

Question 4

In IBS, are symptoms typically relieved by defecation?

Answer 4

Yes

Question 5

What is the non-drug treatment of IBS? (2)

Answer 5

1. Diet recommendations
   
   • eat regularly (avoid skipping meals or leaving long gaps between meals)
   • limit fresh fruit consumption to no more than 3 portions a day
   • review fiber intake; if increased fiber is required, recommend soluble fiber such as ispaghula husk or oats (intake of insoluble fiber should be reduced as it may exacerbate symptoms)
   • increase water consumption
   • decrease caffeine, alcohol, and fizzy drinks, as well as those with artificial sweetener sorbitol
   • probiotics for at least 4 weeks while monitoring side effects
2. Increase physical activity

Question 6

____________ fiber may be useful in treating IBS, while ___________ fiber may exacerbate symptoms

Answer 6

Soluble (eg oats)

Insoluble (eg bran)

Question 7

Choice of drug treatment in patients with IBS depends on ____________ and ____________ of symptoms

Answer 7

Nature (ie constipation or diarrhea)

Severity

Question 8

______________ drugs (such as alverine citrate, mebeverine hydrochloride and peppermint oil) can be taken in addition to dietary and lifestyle changes for patients with IBS

Answer 8

Antispasmodic

Question 9

A _____________ can be used to treat constipation in patients with IBS

Answer 9

Laxative (excluding lactulose which may cause bloating)

Question 10

Patients with IBS and constipation who have not responded to laxatives from the different classes and who have had constipation for at least 12 months, can be treated with ____________.

Answer 10

linaclotide

Question 11

_________________ is the first line anti-motility drug for relief of diarrhea in patients with IBS

Answer 11

Loperamide

Question 12

Patients with IBS should be advised how on to adjust their dose of laxative or anti-motility drug according to ________________

Answer 12

stool consistency, with the aim of achieving a soft, well-formed stool

Question 13

A(n) _______________, can be used for abdominal pain or discomfort as a second-line option in patients who have not responded to antispasmodics, anti-motility drugs, or laxatives

Answer 13

low-dose tricyclic antidepressant, such as amitriptyline hydrochloride [unlicensed indication]

• A selective serotonin reuptake inhibitor may be considered in those who do not respond to a tricyclic antidepressant [unlicensed indication]

Question 14

_________________ can be offered to patients who have no relief of IBS symptoms after 12 months of drug treatment

Answer 14

Psychological intervention