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Gastrointestinal > IBS > Flashcards

IBS Flashcards

1
Q

What is IBS?

A

A chronic, relapsing/remitting syndrome that presents with abdominal pain and bowel dysfunction.

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2
Q

NICE definition of IBS

A

Abdominal pain or discomfort, in association with altered bowel habit, for at least 6 months, in the absence of alarm symptoms or signs - mostly applicable in primary care

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3
Q

When should IBS be suspected?

A

Suspect irritable bowel syndrome (IBS), in the absence of alarm symptoms or signs, if any of the following symptoms have been present for at least 6 months:
1. Abdominal pain or discomfort
2. Bloating
3. Change in bowel habit.

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4
Q

Which other conditions must be ruled out before a diagnosis is amde for IBS?

A
  1. colorectal cancer, small bowel cancer, ovarian cancer and lymphoma
  2. functional/drug induced constipation, hypothyroidism
  3. inflammatory bowel disease, coeliac disease, crohns, antibiotic asociated diarrhoea

see nice cks IBS diagnosis.

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5
Q

How to manage a newly diagnosed IBS patient?

A

The management of irritable bowel syndrome (IBS) should be individualized to the person’s symptoms and psychosocial situation, and should initially include clear explanation of the condition, and diet and lifestyle advice.

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6
Q

Red flags symptoms of IBS?

A
  1. Bloody stool
  2. Fever
  3. multiple episodes of watery diarrhoea
  4. weight loss
  5. fatigue / lethargy
  6. pallor (pale appearance)
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7
Q

Presentation of IBS

A
  1. Abdominal pain - mid/lower abdomen releived by defecation
  2. Bloating
  3. Varaible bowel habit - some may expereince constipation (IBS-C), OR some (IBS-D) Diarrohea, or some may experience a mixed bowel habit
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8
Q

Does IBS cause weight loss?

A

No, patients should be urgently reffered if presented with unexplained weight loss

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9
Q

IBS epidemiology

A
  • Underestimated as most dont seek medical help/diagnosis
  • 10-20% prevelance
  • Age 10-20 diagnosis
  • prevelance < with age
  • More common in females.
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10
Q

Aetiology of IBS

causes

A
  1. Abnormal hypersensitivity to visceral pain (increased sensitivity to intestinal digestion)
  2. Anxiety, depression, stomatisation, panic attacks, acute stress
  3. altered GI motility (rapid contractions & increased,decreased transit times)
  4. Luminal factors - previous gastroentiritis, dietery components, trigger foods, gut micro-flora disturbances
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11
Q

Non-pharmacological treatment of IBS

A
  1. patients should be reassured there is no cancer risk
  2. informed that there is no cure and treatment is to releive symptoms
  3. lifestyle and diet modifications - balanced healthy diet with adjusted fibre intake according to symptoms
  4. if constipation predominant - increase soluble fibres
  5. if diarrhoea predominant - decrease insoluble fibre
  6. stress reduction therapies
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11
Q

Pharmacological treatment of IBS-C

A
  1. reassurance + lifestyle advice
  2. Fybogel 1 sachet bd
  3. +/- osmotic (macrogols) / stimulative (Senna) if indicated
  4. Linaclotide 290mg od before breakfast
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12
Q

Pharmacological treatment of IBS-D

A
  1. Reassurance + lifestyle advice
  2. Loperamide 4mg initally, then 2mg after each loose stool
    or
    Codeine 30mg QDS
  3. Amitryptiline 5-10mg at night
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13
Q

When should Linalcotide be used in the treatment of IBS?

A
  1. 2nd line for constipation - max dose of previous laxatives have not helped and pt had constipation >12 months.
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14
Q

Linaclotide: Dose, Side effects, MOA, Contraindications

A

Linaclotide for moderate/sever IBS.
1. Dose: 290mcg daily before meals.
2. reviewed after 4 weeks
3. 18+
4. contraindicated in people with GI obstruction, IBD, Pregnant
5. Side effects: Abdominal distention, abdominal pain, diarrhoea, dizziness, flatulence
6. MOA: Linaclotide is a guanylate cyclase-C agonist. It works by increasing intracellular cyclic GMP (cGMP), which stimulates the secretion of chloride and bicarbonate into the intestinal lumen through the CFTR ion channel. This leads to increased intestinal fluid secretion and accelerated transit, helping to relieve constipation. It also reduces visceral pain by lowering the activity of pain-sensing nerves in the gut.

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15
Q

How does Fybogel work?

A

Fybogel (Ispaghula husk) - act by retaining fluid within the stool and increasing faecal mass, stimulating peristalsis; also have stool-softening properties.

16
Q

How do stimulant laxitives work? give examples

A

Stimulant laxatives cause peristalsis by stimulating colonic nerves (senna) or colonic and rectal nerves (bisacodyl, sodium picosulfate).

17
Q

What is peristalsis?

A

a series of involuntary muscle contractions that move food, urine, and bile through the body.

18
Q

Indication of antispasmodic drugs in IBS

A
  • Antispasmodic drugs may be used as required for abdominal pain or spasm in irritable bowel syndrome (IBS)
  • Less likely to cause adverse effects compared with antimuscarinics such as hyoscine butylbromide and dicycloverine.
19
Q

Antispasmodics used in IBS

A
  1. Alverine citrate - 60mg-120mg up to TDS.
  2. Mebeverine 135mg-150mg TDS
    or mebeverine 200mg m/r bd
  3. Peppermint oil EC caps - 1-2 TDS up to three months if needed 30mins before meals
20
Q

Contraindications smooth muscle relaxants IBS

A

People with:
* intestinal obstruction
* paralytic ileus (muscles that move food through intestines stop working)
* Pregnant

21
Q

Indication of antidepressants in IBS

A
  • Tricyclic antidepressants (TCAs) such as amitriptyline, may be used for the management of pain associated with IBS (off-label indication).
  • Selective serotonin reuptake inhibitors (SSRIs) such as sertraline, citalopram or fluoxetine are second-line drug options (off-label indication).
22
Q

SSRIs in IBS

A
  • NICE recommend that SSRIs are only considered in people who do not respond to a tricyclic antidepressant
  • Guidlines don’t specify an SSRI by choice
23
Q

TCA’s in IBS

A

amitriptyline 5–10 mg at night, and titrating the dose up in steps of 10 mg at least every 2 weeks if needed, to a maximum of 30 mg at night

24
Q

Rome IV criteria

A

Recurrent abdominal pain, on average, at least 1 day per week in the last 3 months (with symptom onset at least 6 months prior to diagnosis) which is associated with two or more or the following:
* Related to defaecation;
* Change in frequency of stool;
* Change in stool form.

Patients are sub-grouped according to predominant Bristol stool type to help direct treatment:
IBS with diarrhoea (IBS-D).
IBS with constipation (IBS-C).
IBS with mixed bowel habits (IBS-M).
IBS unclassified (IBS-U) where symptoms meet the criteria for IBS but do not fall into one of the three subgroups above according to Bristol stool type.

Gastrointestinal (7 decks)

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