IBS

Question 1

What is IBS?

Answer 1

Functional GI disorder (FGID) where there are no underlying disease related to the symptoms

Question 2

Cause of IBS?

Answer 2

Unknown: believed to be due to impaired brain - gut interaction

Question 3

Risk factors for IBS? (4)

Answer 3

1. Young females
2. Psychosocial (anxiety, depression, stress)
3. post-infection
4. endometriosis

Question 4

Classical presentation of IBS? (6)

Answer 4

“ABCD”

1. Abdominal pain
2. Bloating/distension
3. Change in bowel habits (constipation/diarrhoea)
4. Defecation provides relief
5. Worst with food
6. PR mucus

Question 5

How long does symptoms need to go on for to be considered as IBS according to the Rome IV criteria?

Answer 5

At least once a week for 3 months

Question 6

Investigations in IBS? (4)

Answer 6

1. Bloods - FBC, CRP (rule out inflammation)
2. Stool MSC, ova, cysts, parasites, C.diff toxin (gastroenteritis)
3. Faecal Calprotectin (IBD)
4. Coeliac Serology

Question 7

How is IBS diagnosed?

Answer 7

Diagnosis of exclusion

Question 8

Management of IBS?

Answer 8

1. Eating advice - low FODMAP diet, small portions, less processed foods, adequate fluids
2. Anti-diarrhoea (e.g., Loperamide)
3. Constipation management - bulk forming laxatives (e.g., Isphaghula husk)
4. Antispasmodic (e.g., Buscopan/Hyoscine, Mebeverine)

Question 9

Type of diet to recommend to patients with IBS?

Answer 9

low FODMAP (e.g. some fruit and veg, milk, wheat)

Question 10

Why are low FODMAP diets recommended?

Answer 10

Foods high in FODMAP are hard for the gut to break down.

Question 11

What type of laxative should be avoided in IBS? Why?

Answer 11

Lactulose - causes bloating

Question 12

Red flags for an alternative diagnosis of IBS (7)

Answer 12

Symptoms >50 years 
PR bleed
Weight loss 
Palpable mass 
Nocturnal diarrhoea 
Anaemia 
Raised inflammatory markers

Question 13

Romes IV classification of IBS?

Answer 13

IBS-C: Constipation >25% of bowel motions
IBS-D: Diarrhoea >25% of bowel motions
IBS- M (mixed): Constipation >25% and Diarrhoea >25%
IBS-U (unclassified): cannot classify into a subtype

Question 14

2nd line treatment option for IBS? (2)

Answer 14

Antidepressants:

1. tricyclic antidepressants (e.g. amitriptyline)
2. SSRIs (e.g. citalopram)