IBS

Question 1

When should a diagnosis of IBS be considered?

Answer 1

Abdominal pain, and/or
Bloating, and/or
Change in bowel habit

Question 2

What is the criteria for IBS diagnosis?

Answer 2

Abdo pain relieved by defaecation or associated with altered bowl habit
+ 2 of the following

• Altered stool passage
• Bloating, distention or hardness
• Symptoms made worse by eating
• Mucus

Question 3

What comprises altered stool passage?

Answer 3

Straining
Urgency
Incomplete evacuation

Question 4

What are some other supportive symptoms?

Answer 4

Nausea
Backache
Bladder symptoms

Question 5

What are red flag symptoms?

Answer 5

rectal bleeding
unexplained/unintentional weight loss
family history of bowel or ovarian cancer
onset after 60 years of age

Question 6

What are some investigations in primary care for IBS?

Answer 6

full blood count
ESR/CRP
coeliac disease screen (tissue transglutaminase antibodies)

Question 7

What is the 1st line pharmacological treatment for IBS?

Answer 7

pain: antispasmodic agents
constipation: laxatives but avoid lactulose
diarrhoea: loperamide is first-line

Question 8

When would linclotide (alt. laxative) be considered?

Answer 8

Max doses of other laxatives ineffective

Constipation for 12 months

Question 9

What is 2nd line pharmacological treatment for IBS?

Answer 9

low-dose tricyclic antidepressants (e.g. amitriptyline 5-10 mg

Question 10

What are some other management options for IBS?

Answer 10

Psychological interventions

Alternative medicines

Question 11

What general dietary advice should be given to those with IBS?

Answer 11

Regular meals
8 cups of fluid a day
Restrict caffeine
Reduce alcohol and fizy drinks
Limit high fibre foods