IBS Flashcards
What is IBS
A disorder of enhanced visceral perception for which no organic cause can be found i.e. abnormal functioning of an otherwise normal bowel
Epidemiology
Very common
Affects 20% of population
Affects F>M
More common in young adults
Symptoms
Diarrhoea Constipation Fluctuating bowel habit Abdominal pain/cramps Bloating Worse after eating Improved on defecating
NICE guidelines investigations/criteria for diagnosis
Normal bloods: FBC, CRP and ESR
Negative faecal calprotectin for IBD
Negative anti-TTG coeliac serology
Cancer is not suspected or excluded if suspected
ROME criteria for diagnosis
Abdo discomfort/pain for >12 weeks which has 2 of: - relieved by defecation - change in stool frequency - D or C - change in stool form: pellets or mucus \+2 of: - urgency - incomplete evacuation - abdo bloating/ distension - mucus PR - worsening symptoms after food
Exclusion criteria:
- > 40 years
- Bloody stool
- Anorexia
- Weight loss
- Diarrhoea at night
Investigations for IBS
FBC, LFT, ESR, CRP, TSH
Faecal calprotectin
Anti-TTG/ anti-endomysial coeliac serology
Colonoscopy if >60 years or any features of organic disease
Conservative management of IBS
Making a diagnosis and reassurance that there is no serious pathology is important General health and diet advice: Adequate fluid intake Regular small meals Reduced processed foods Limit caffeine and alcohol Low FODMAP diet - with dietician guidance ideally Trial of probiotics for 4 weeks
Medical management of IBS symptoms
First line symptomatic meds:
Loperamide for diarrhoea
Laxatives for constipation but avoid lactulose as can cause bloating
- Linaclotide is used specifically for IBS not responding to first line laxatives
Antispasmodic medication - hyoscine butylbromide (Buscapan)/ mebeverine
Second line:
Amitriptylline 5-10mg ON
Third line:
SSRIs
+ CBT - psychologically manage the condition and reduce distress associated with the symptoms
