IBS Flashcards
mainly affects
20-30 yr olds
more common in
women
symptoms
- abdominal pain or discomfort
- disordered defecation (e.g. either diarrhoea, or constipation with straining, urgently and incomplete evacuation)
- mucus in poo
- bloating
non drug treatment
- increase physical activity
- eat regularly without missing meals or leaving long gaps between meals
- limit fresh fruit consumption to max 3 portions a day
- review fibre intake - if increase required, recommend soluble fibre e.g. isphagula husk or foods high in soluble fibre e.g. oats
- insoluble fibre e.g. bran and resistant starch should be discouraged as it may exacerbate symptoms
- increase fluid intake to at least 8 cups a day
- reduce caffeine, alcohol, fizzy drinks
- avoid sorbitol in pt with diarrhoea
probiotics
if being used, continue for at least 4 weeks while monitoring effects
if symptoms persist following lifestyle and dietary advice
single food avoidance and exclusion diets may be an option under supervision of dietician or medical specialist
name antispasmodics
peppermint oil
alverine citrate
mebeverine hydrochloride
which laxative is not recommended in IBS
lactulose - can cause bloating which can worsen symptoms
drug treatment
- depends on nature and severity of symptoms
- antispasmodics can be taken in addition to diet and lifestyle changes
- laxative can be used for constipation (not lactulose due to bloating)
- loperamide for anti-diarrhoea relief
when can linaclotide be offered
- if pt has not responded to laxatives from different classes and have has constipation for at least 12 months
- this is indicated for moderate to severe irritable bowel syndrome with constipation
dose of linaclotide
290 micrograms once daily, dose to be taken at least 30 minutes before meals, review treatment if no response after 4 weeks.
Low dose TCA e.g. amitriptyline and SSRI
(unlicensed indication)
- Can be used for abdominal pain or discomfort as 2nd line option in pt who have not responded to antispasmodics, anti-motility drugs or laxatives
- SSRI may be considered in those who don’t respond to TCA
Mebeverine OTC
- for symptomatic relief of IBS; max single dose is 135mg and max daily dose If TDS (405mg)
- for uses other than symptomatic relief of IBS; max single dose 100mg, max daily dose 300mg
dose of mebeverine 200mg MR for IBS
200mg BD
mebeverine contraindication
paralytic ileus
