IBS Flashcards
What is the pathophysiology of IBS?
IBS is a functional disorder that is caused by a disturbance of the gut-brain interaction
What are the key features of IBS?
Abdominal pain
Bloating
Change in bowel habit
Stool abnormalities - watery/hard/associated with mucus
Symptoms persisting for at least six months
What are the common symptoms of IBS?
Abdominal pain
Diarrhoea
Constipation
Fluctuating bowel habit
Bloating
Worse after eating
Improved by opening bowels
Passing mucus
What are common triggers for IBS?
Anxiety
Depression
Stress
Sleep disturbance
Illness
Medications
Certain foods
Caffeine
Alcohol
What are the differentials of IBS?
Bowel cancer
Inflammatory bowel disease
Coeliac disease
Ovarian cancer
Pancreatic cancer
What red flag features should be ruled out when investigating IBS?
Rectal bleeding
Unexplained weight loss
Family history of bowel or ovarian cancer
Onset after 60 years of age
What are the initial investigations for IBS?
FBC
ESR
CRP
Coeliac disease screen
Faecal calprotectin
CA125
What are the criteria for diagnosis of IBS?
At least 6 months of abdominal pain with at least one of:
- Pain or discomfort relieved by opening bowels
- Bowel habit abnormalities
- Stool abnormalities
At least two more symptoms of:
- Straining, an urgent need to open bowels
- Bloating
- Worse after eating
- Passing mucus
What lifestyle advice can be offered to those with IBS?
Drinking enough fluids
Regular small meals
Adjusting fibre intake according to symptoms
Limit caffeine, alcohol and fatty foods
Low FODMAP diet
Probiotic supplements
Reduce stress
Exercise regularly
What are the first line medical treatments of IBS?
Diarrhoea - loperamide
Constipation - bulk-forming laxatives
Cramps - antispasmodics such as mebeverine, hyoscine butylbromide
What is the second line medical management of IBS?
Low dose tricyclic antidepressants - amitriptyline
SSRI antidepressants
CBT
Linactolide
