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
anti - spasmoidic
