IBS Flashcards
Give an example of a functional bowel disorder.
IBS.
What is IBS?
Irritable Bowel Syndrome:
A chronic functional bowel disorder characterised by abdominal pain and change in bowel habits; and with no organic cause found.
Give 5 main causes of IBS.
- Depression, anxiety
- Psychological stress and trauma
- GI infection
- Sexual, physical or verbal abuse
- Eating disorders
More likely in women and in younger people
Describe the multi-factorial pathophysiology of IBS.
The following factors can all contribute to IBS:
- Psychological morbidity e.g. trauma in early life.
- Abnormal gut motility.
- Genetics.
- Altered gut signalling (visceral hypersensitivity).
Dysfunction in the brain-gut axis results in disorder of intestinal motility and or enhanced visceral perception (visceral hypersensitivity)
Give 3 symptoms of IBS.
ABC:
1. Abdominal pain (pain improves with defecation)
2. Bloating
3. Change in bowel habits
4. Symptoms are worse after eating
Give 3 non-intestinal symptoms of IBS.
- Painful period
- Urinary frequency, urgency, nocturia and incomplete emptying of bladder
- Back pain
- Joint hypermobility
- Fatigue
Criteria of symptoms to suggest IBS.
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
How many types of IBS are there?
What are they?
3 types:
* IBS-C - with constipation
* IBS-D - with diarrhoea
* IBS-M - with constipation and diarrhoea
Investigations to diagnose IBS.
Since nothing physical to be found, diagnosis made by ruling out the differentials!!
Diagnosis of exclusion:
- Anti-tTG (tissue transglutaminase antibody) or anti-EMA (endomysial antibody) = Coeliac Disease
- Faecal calprotectin = IBD
- Bloods
- FBC = anaemia
- ESR + CRP = inflammation - Colonoscopy = Colorectal Cancer / IBD
Diagnostic criteria for IBS.
Rome IV diagnostic criteria:
- Recurrent abdominal pain/discomfort at least 3 days a month in the past 3 months, associated with two or more of the following:
- Improvement with defecation
- Onset associated with a change in frequency of stool
- Onset associated with a change in form (appearance) of stool
Give an example of a differential diagnosis for IBS.
- Coeliac disease.
- Lactose intolerance.
- Bile acid malabsorption.
- IBD.
- Colorectal cancer.
Describe the treatment for mild IBS.
- Education
- Reassurance
- Dietary modification e.g. FODMAP
Describe the treatment for moderate IBS.
Pharmacotherapy and psychological treatments:
- Antispasmodics for pain.
- Laxatives for constipation.
- Anti-motility agents for diarrhoea.
- CBT and hypnotherapy.
Describe the treatment for severe IBS.
MDT approach, referral to specialist pain treatment centres.
- Tri-cyclic anti-depressants.
Describe the lifestyle modification advice given for IBS.
- Regular or small frequent meals
- Plenty of fluids (8 cups/day)
- Reduce/avoid caffeinated drinks, alcohol and fizzy drinks
For IBS-D and bloating, reduce/avoid:
- Insoluble fibre intake
- Fruit intake to 3 portions/day
- For wind and bloating increase:
- Soluble fibre intake
- Fibre:
- Soluble:
* Good for CONSTIPATION (IBS-C)
* Dissolves in water and broken down by bacteria
* Softens stool
* Slows down sugar release
* E.g. barley, oats, beans, prunes, figs
- Insoluble:
- Makes IBS-D WORSE! so cut down
- Not dissolved in water
- Passes through the gut mostly unchanged
- Absorbs water and bulks up faeces
- Increases gut motility
- E.g. cereals, whole-wheat bread, lentils, apple, avocado
