IBS

Question 1

Symptoms of IBS?

Answer 1

Diarrhoea
Constipation
Fluctuating bowel habit
Abdominal pain
Bloating
Worse after eating
Improved by opening bowels

Question 2

Diagnosis of IBS

Answer 2

Other pathology should be excluded:

Normal FBC, ESR and CRP blood tests
Faecal calprotectin negative to exclude inflammatory bowel disease
Negative coeliac disease serology (anti-TTG antibodies)
Cancer is not suspected or excluded if suspected

Symptoms should suggest IBS:

Abdominal pain / discomfort:

Relieved on opening bowels, or
Associated with a change in bowel habit
AND 2 of:

Abnormal stool passage
Bloating
Worse symptoms after eating
PR mucus

Question 3

Management of IBS

Answer 3

General healthy diet and exercise advice:

Adequate fluid intake
Regular small meals
Reduced processed foods
Limit caffeine and alcohol
Low “FODMAP” diet (ideally with dietician guidance)
Trial of probiotic supplements for 4 weeks

First Line Medication:

Loperamide for diarrhoea
Laxatives for constipation. Avoid lactulose as it can cause bloating. Linaclotide is a specialist laxative for patients with IBS not responding to first-line laxatives
Antispasmodics for cramps e.g. hyoscine butylbromide (Buscopan)

Second Line Medication:

Tricyclic antidepressants (i.e. amitriptyline 5-10mg at night)

Third Line Medication:

SSRIs antidepressants

Cognitive Behavioural Therapy (CBT) is also an option to help patients psychologically manage the condition and reduce distress associated with symptoms.