IBS

Question 1

How is IBS characterized?

Answer 1

chronic abdominal pain + altered bowel habits in the absence of any known organic cause

Question 2

Epidemiology of IBS?

Answer 2

Female :Male 2:1

symptoms at <45 years of age

Question 3

Pathophysiology of IBS? (5)

Answer 3

• Motility disorder
• Visceral Hypersensitivity
• Intestinal Inflammation
• Intestinal Microbial changes
• Psychological

Question 4

Main culprit of symptoms on IBS?

Answer 4

abn colonic motility

Question 5

What causes pain in IBS?

Answer 5

Increased visceral sensitivity to pressure and pain stimulus

Question 6

What IBS symptoms may result from slow GI transit?

Answer 6

bloating and distension (which are painful due to hypersensitivity)

Question 7

How can we tell intestinal inflammation may be present in IBS?

Answer 7

increased inflammatory markers (TNF and other cytokines)

Question 8

What microbial abn may be present in IBS?

Answer 8

Post Infectious IBS

Alteration in Gut microbes

Bacterial Overgrowth

Question 9

IBS patients tend to be more freq diagnosed with:

Answer 9

psychological disorders

particularly, abuse

Question 10

Possible mediating factor related to IBS and psych disorders?

Answer 10

Corticotropin Releasing factor

Question 11

Rome III Diagnostic Criteria for Irritable Bowel Syndrome Irritable Bowel Syndrome:

Answer 11

Recurrent abd pain or discomfort for 3 consecutive days a month in last 3mo associated with 2 or more of the following:

• Improvement w/ defecation
• Onset asst’d w/ change in freq of stool
• Onset asst’d w/ change in appearance of stool

Question 12

According to the Manning criteria, likelihood of IBS increases with presence of what symptoms?

Answer 12

1. Pain relieved with defecation
2. More frequent stools at onset of pain
3. Looser stool at the onset of pain
4. Visible abdominal distention
5. Passage of mucus
6. Sensation of incomplete evacuation

Question 13

IBS-C is associated with…

IBS-D is associated with…

Answer 13

Hard stool >25% of stool

Loose/watery stool >25% of stool

Question 14

Mixed IBS is associated with…

Answer 14

Loose and hard stool alternate >25% each

Question 15

Diarrhea in IBS is defined/characterized as…

Answer 15

frequent (>3 stools/day) non-bloody stools of small volume that may be associated with urgency or feeling of incomplete evacuation

Question 16

What is the timing of diarrhea in IBS?

Answer 16

Usually AM or post-prandial, but does NOT awaken patient

Question 17

Constipation in IBS is defined/characterized as…

Answer 17

< 3 stools/week which may be hard/pellet

Constipation may be constant or intermittent

Question 18

Most frequent type of altered bowel habits seen in IBS?

Answer 18

Alternating Diarrhea/Constipation

Question 19

Differential Diagnosis of Irritable Bowel Syndrome (FYI)

Answer 19

Abx-associated diarrhea
Hypo/hyperthyroidism
Medications
Endometriosis
Celiac Sprue
Lactose intolerance
Infectious diarrhea
Colorectal cancer
Diverticulitis
IBD

Question 20

Red Flags in Diagnosis of IBS in history?

Answer 20

Hx of wt loss, severe chronic diarrhea or constipation, rectal bleeding

Onset of sx in patient >50 y/o

Recent travel or abx use

Family hx of GI cancer, sprue, or IBD

Question 21

Red flags in Diagnosis of IBS in physical/labs?

Answer 21

arthritis, lymphadenopathy, abdominal mass

Anemia, abnormal thyroid tests, abnormal calcium, abnormal liver tests, leukocytosis

Question 22

Treatment of IBS?

Answer 22

• Education
• Reassurance
• Dietary modification
• Drug treatment (for pain, constipation or diarrhea)
• Psychological treatment

Question 23

Dietary Treatment of IBS?

Answer 23

For some pts: fatty foods, alcohol, caffeine, beans

Food diary

Question 24

Drug treatment of IBS for nml patients?

Answer 24

Fiber (constipation)

Loperamide (symptomatic control of diarrhea)

Anti-cholinergics (pain and bloating)

Question 25

Drug treatment of IBS for severe symptoms?

Answer 25

1. Tricyclic antidepressants
2. Selective serotonin reuptake inhibitors

**antidepressants modulate GI motility, and may modulate visceral hyperesthesia