IBS

Question 1

Etiology of IBS

Answer 1

Overreaction through gut 5-HT
Stimuli:
Diet, stress, certain activity

Question 2

Symptoms of IBS

Answer 2

> 6 months of duration
Pain/spasms, bloating/fullness
Urgency, mucous in stool
Constipation or diarrhea
Abdominal pain
Abnormal bloating distension (75-90% in women)

Question 3

What are the 3 types of IBS?

Answer 3

IBS-D
IBS-C
Food intolerance IBS

Question 4

IBS-D

Answer 4

47.3% of cases
More than 2x normal amount of BMs
Sudden immediate urge

Question 5

IBS-C

Answer 5

32% of cases
Fewer then 3 BM per week
Sensation of an incomplete BM

Question 6

Food intolerance IBS

Answer 6

70% of IBS from food trigger
Actively avoid certain foods

Question 7

Differential for IBS

Answer 7

IBD - blood in stools
Lactose or gluten intolerance
Drug-induced
Colorectal cancer

Question 8

Treatment options for IBS-C

Answer 8

Dietary
Bulk-forming agents
Smooth-muscle relaxants
Laxatives
Peppermint oil
Anti-depressants
Probiotics

Question 9

Treatment options for IBS-D

Answer 9

Dietary
Smooth-muscle relaxants
Anti-diarrheal
Peppermint oil
Anti-depressants
Probiotics

Question 10

Dietary use for IBS

Answer 10

Dietary fibre
Reduce fatty foods
Avoid trigger foods
Beano / lactaid

Question 11

Bulk forming agent use for IBS

Answer 11

Psyllium/bran(recommendation)
PEG 3350 (less effective)

Question 12

Smooth-muscle relaxants use for IBS

Answer 12

Create less spasm / better co-ordination
Best if used regularly

Question 13

What are the two smooth muscle relaxants?

Answer 13

Pinaverium
Trimebutine

Question 14

MOA of pinaverium

Answer 14

Calcium channel antagonist - muscle relaxation

Question 15

MOA of trimebutine

Answer 15

Opiate receptor agonist / 5 HT3 antagonist

Question 16

What are the anti-diarrheals?

Answer 16

Loperamide
Viberzi (eluxadoline)

Question 17

Dosing for loperamide

Answer 17

Take 2-4mg 45 minutes before leaving home to prevent sudden urgency

Question 18

Downside to viberzi(eluxadoline)

Answer 18

Very expensive

Question 19

Laxative options for IBS

Answer 19

Senokot
Bisacodyl Lactulose
Magnesium hydroxide
Polyethylene glycol

Question 20

Uses of peppermint oil in IBS

Answer 20

For Symptoms: pain, spasms, bloating, gas (mildly effective)
For IBS-D: IBgard (menthol + peppermint oil) - take 30 minutes prior to meals for less spasms

Question 21

Anti-depressants in IBS-D

Answer 21

TCAs - for pain / diarrhea
Amitriptyline and desipramine

Question 22

Anti-depressants for IBS-C

Answer 22

SSRIs - treat IBS-C
Seems to reduce pain

Question 23

Anti-cholinergic use in IBS

Answer 23

NOT first line agents for IBS
Less effective + more side effects

Question 24

What are the rx medications for IBS-C?

Answer 24

Tegaserod (zelnorm) - discontinued
Linaclotide (for moderate-severe)
Lubiprostone (for opioid caused)
Tenapanor

Question 25

What are the rx medications for IBS-D?

Answer 25

Alosetron (lotronox)
Zaxine 500 - locally acting antibiotic

Question 26

Side effect of alosetron (lotronox)

Answer 26

Overuse -> caused ischemic colitis

Question 27

Side effect of tegaserod (zelnorm)

Answer 27

Diarrhea