IBS

Question 1

What is Irritable Bowel Syndrome (IBS)?

Answer 1

IBS is a functional disorder where there is a disturbance in the gut-brain interaction, causing abdominal and intestinal symptoms. There is no underlying bowel disease, and the symptoms arise from abnormal functioning of an otherwise normal bowel. It affects up to 20% of the population, with a higher prevalence in women and younger adults.

Question 2

What are the key features of IBS that can be remembered with the ‘IBS’ mnemonic?

Answer 2

I – Intestinal discomfort (abdominal pain related to the bowels)
B – Bowel habit abnormalities (e.g., diarrhea or constipation)
S – Stool abnormalities (watery, loose, hard stools, or mucus)

Question 3

What are common symptoms of IBS?

Answer 3

• Abdominal pain
• Diarrhoea or constipation
• Fluctuating bowel habits
• Bloating
• Symptoms worse after eating
• Improved by opening bowels
• Passing mucus

Question 4

What factors can trigger or worsen IBS symptoms?

Answer 4

• Anxiety
• Depression
• Stress
• Sleep disturbance
• Illness
• Medications
• Certain foods
• Caffeine
• Alcohol

Question 5

What are the key differential diagnoses to consider when evaluating IBS symptoms?

Answer 5

• Bowel cancer
• Inflammatory bowel disease
• Coeliac disease
• Ovarian cancer (particularly in women over 50)
• Pancreatic cancer

Question 6

What are the diagnostic criteria for IBS according to NICE guidelines (2022)?

Answer 6

For IBS diagnosis, the patient must have:
* At least 6 months of abdominal pain or discomfort
* At least one of the following:
* Pain or discomfort relieved by opening the bowels
* Bowel habit abnormalities (more or less frequent)
* Stool abnormalities (watery, loose, or hard)
Additionally, at least two of the following:
* Straining, urgency, or incomplete emptying
* Bloating
* Symptoms worse after eating
* Passing mucus

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Question 7

What investigations are commonly used to rule out other conditions when diagnosing IBS?

Answer 7

• Full blood count (to check for anaemia)
• Inflammatory markers (e.g., ESR and CRP)
• Coeliac serology (anti-TTG antibodies)
• Faecal calprotectin (for inflammatory bowel disease)
• CA125 (for ovarian cancer)

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Question 8

What lifestyle changes are recommended to manage IBS?

Answer 8

• Drink enough fluids
• Eat regular small meals
• Adjust fibre intake (more for constipation, less for diarrhoea/bloating)
• Limit caffeine, alcohol, and fatty foods
• Low FODMAP diet (guided by a dietician)
• Probiotics (may be helpful, but discontinue after 12 weeks if no benefit)
• Reduce stress
• Regular exercise

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Question 9

What are the first-line medications for managing IBS symptoms?

Answer 9

• Loperamide for diarrhoea
• Bulk-forming laxatives (e.g., ispaghula husk) for constipation
• Antispasmodics (e.g., mebeverine, alverine, hyoscine butylbromide, or peppermint oil) for cramps

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Question 10

What specialist medications are used when first-line treatments are inadequate in IBS?

Answer 10

• Linaclotide (for constipation in IBS)
• Other options include:
  
  • Low-dose tricyclic antidepressants (e.g., amitriptyline)
  • SSRI antidepressants
  • Cognitive behavioural therapy (CBT)
  • Specialist referral for further management

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Question 11

What is the evidence for antispasmodic medications in IBS?

Answer 11

There is weak evidence supporting the benefit of antispasmodic medications in IBS, and they may cause side effects.

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