IBS Flashcards
define
Irritable bowel syndrome is a chronic, functional bowel disorder characterised by abdominal pain and altered bowel habits.
Epidemiology
Younger
F>M
Aetiology (6)
- Motility problems
- Visceral hypersensitivity
- Altered mucosal and immune function
- Gut microbiome alteration
- Food sensitivity
- Psychosocial factors - Stress
types
IBS-D; Diarrhoea
IBS-C; Constipation
IBS-M; Mixed
risk factors
- Female sex
- Younger age
- Stressful life events
- Anxiety and/or depression
- Gastrointestinal infection
- Endometriosis
clinical manifestations
- Stressful period - change in bowel habit
- Abdo pain w/ bloating relieved after defecating
- Diarrhoeal or constipation
- Nausea
- Belching
- Weightless
pathophysiology
- caused by distrurbance of the gut-brain interaction
- results in troublesome abdominal and intinestinal symptoms
- function disorder - no identifiable bowel disease
- Stress induced
investigations
- Full blood count - rule out infective causes
- C-reactive protein / ESR - exclude IBS
- Faecal calprotectin - Used to differentiate between IBS and IBD - normal in IBS
- Coeliac serology (anti-TTG) - rule out IBS
- CA125 - ovarian cancer
- deranged MCV - malabsorption
- TFT
- CA125 is indicated in women with IBS symptoms
differential diagnosis
Coeliac and IBD - Rule out
first line management IBS-related diarrhoea
Loperamide - anti-motility - used for lots of diarrhoea conditions
1st line IBS-related constipation
Low-FODMAP diet
High fibre diet
Senna - stimulant laxative
Avoid lactulose as it can cause bloating
not loperamide
treatment if experiencing cramps
If cramps - anti-spasmodic eg hyoscine butylbromide (Buscopan)
2nd line management
Tricyclic antidepressant - eg amitriptyline
3rd line treatment
SSRI antidepressants
rome IV IBS diagnostic criteria for each type
definition:
- recurrent abdominal pain
- at least 1 day a week
- for the last 3 months
- associated with 2+ of the following criteria:
IBS-C (constipation)
- type 1
- type 2
IBS-D (diarrhoea)
- type 5
- type 6
IBS-M (mixed)
- type 1
- type 6
type 1 - seperate hard lumps
type 2 - lumpy and sausage like
type 5 - soft blobs with clear cut edges
type 6 - mushy consistency with ragged edges
change in stool appearance must be >25% of stools to meet diagnostic criteria
FODMAP diet
fermentable oligosaccharides, disaccharides, monosaccharides and polyols
translated to foods:
AVOID
onions
wheat, rye, barley
milk
soft cheese
yoghurt, ice cream, butter
high fructose fruits
high fructose corn syrups
sugar free gum, mints
fruits like apples, pears, peaches
Mebeverine hydrochloride
anti-spasmodic - treats symtpoms of IBS
Mebeverine
anti - spasmoidic
overall IBS management
Dietary and lifestyle modifications:
- stress management
- low FODMAP diet
Pharmacotherapy:
antispasmodics: such as mebeverine, laxatives, or anti-diarrhoeal agents may be used depending on the predominant symptoms.
2nd-line medications include low-dose tricyclic antidepressants
Refractory IBS - symptoms not improving for 12 months; psychotherapy advised, including: cognitive-behavioral therapy, hypnotherapy, and mindfulness-based therapy
