IBS

Question 1

What is IBS?

Answer 1

Functional bowel disorder
Recurrent episodes of abdominal pain/ discomfort (in absence of detectable organic pathology) for > 6/12, associated with 2 of the following: 
Altered stool passage  
Abdominal bloating  
Symptoms made worse by eating  
Passage of mucous

Question 2

What is the aetiology causing IBS?

Answer 2

UNKNOWN 
Could be:
visceral sensory abnormalities
gut motility abnormalities
psychosocial factors (e.g. stress)
food intolerance (e.g. lactose)

Question 3

What is the epideimiology of IBS?

Answer 3

COMMON
10-20% of adults
F > M

Question 4

List 6 symptoms of IBS

Answer 4

> 6/12 abdo pain  
Altered bowel frequency (> 3 motions per day or < 3 motions per week)  
Abdominal bloating 
Change in stool consistency  
Passage with urgency or straining  
Tenesmus

Question 5

What 4 should RED FLAG SYMPTOMS should you be suspicious of?

Answer 5

Weight loss
Anaemia
PR bleeding
Late onset (> 60 yrs)

Question 6

What are the signs of IBS?

Answer 6

Usually NORMAL O/E

Abdomen may appear distended + be mildly tender on palpation in 1 or both iliac fossae

Question 7

What samples are used to exclude other differentials of IBS?

Answer 7

Blood: FBC (anaemia), LFT, ESR, CRP, TFT, anti-endomysial/anti-tranglutaminase antibodies (coeliac disease)
Stool examination: microscopy + culture for infective cause

Question 8

What are the complications of IBS?

Answer 8

Physical + psychological morbidity

Increased incidence of colonic diverticulosis

Question 9

What is the prognosis for patients with IBS?

Answer 9

Chronic relapsing + remitting course of disease

Often exacerbated by psychosocial stresses

Question 10

Describe the pain experienced in IBS

Answer 10

Often colicky
In lower abdomen
Relieved by defecation or passing of flatus

Question 11

What investigations other than blood and stool would you perform in IBS?

Answer 11

US: exclude gallstone disease
Urease breath test: exclude Helicobacter pylori
Endoscopy: if other pathologies suspected

Question 12

What non pharmacological treatments are used for IBS?

Answer 12

Advice: dietary modification

Psychological therapy: CBT, Relaxation + psychotherapy

Question 13

What pharmacological treatments are used for IBS?

Answer 13

Antispasmodics (e.g. buscopan)
Prokinetic agents (e.g. domperidone, metaclopramide)
Anti-diarrhoeals (e.g. loperamide)
Laxatives (e.g. senna, movicol, lactulose)
Low-dose TCAs (may reduce visceral awareness)