IBS

Question 1

What is the effect of visceral hypersensitivity in IBS patients?

Answer 1

IBS patients perceive more severe pain on gut distention as compared to control subjects

Question 2

How does the interaction of ENS and GALT cause symptoms of IBS?

Answer 2

mucosal mast cells live in close proximity to enteric nerves and release of inflammatory mediators may effect nerve function and muscle contractility; altered interaction may be responsible for the symptoms of IBS

Question 3

Recall the Rome III IBS diagnostic criteria.

Answer 3

recurrent abdominal pain or discomfort at least 3 days per month in the last 3mo associated with 2+ of the following:

improvement with defecation
onset associated with change in frequency of stool
onset associated with a change in form of stool

symptom onset must be at least 6mo prior to diagnosis

Question 4

What are the 3 subtypes of IBS?

Answer 4

IBS with constipation (hard/lympy too >25%)
IBS with diarrhea (loose, watery stools >25%)
Mixed IBS: (hard/ lumpy >25% and loose/watery >25%)

Question 5

T/F Functional gut disorders are usually stable after onset.

Answer 5

false: functional gut disorders may not be stable or single and they may have variable presentation

Question 6

What are risk factors for post infectious IBS.

Answer 6

female gender
severe diarrhea illness
weight loss >10lbs during illness
bloody diarrhea
pre-existing anxiety or depression

Question 7

What diagnostic testing is recommended for patients with and without alarm symptoms?

Answer 7

limited or no diagnostic testing in patients with no alarm features meeting the Rome III criteria

routine colonoscopy in patients >50yo or patients with alarm symptoms

Patients with IBS-D or IBS-M should be screened for celiac disease (duodenal biopsy, anti TTG antibodies

Question 8

What are alarm symptoms for IBS?

Answer 8

unintentional weight loss
onset after 50yo
FHx cancer or IBD
anemia
increased WBC, CRP
abnormal TSH
abnormal exam
rectal bleeding/obstruction 
positive FOBT

Question 9

What are the components of the low FODMAP diet

Answer 9

low intake of
Fermentable:
Oligosaccharides (Fructans and Galactans)
Disaccharides (lactose)
Monosaccharides (excess fructose)
Polyols (sorbitol, mannitol, maltitol, xylitol etc)

Question 10

What medical treatments can be helpful in IBS?

Answer 10

1. fiber, bulking agents and laxatives: psyllium, PEG
2. some antispasmotics: dicyclomine, pepeprment oil etc.
3. loperamide in tx diarrhea, stool frequency and stool consistency
4. short course rifaximin has limited evidence for global symptoms
5. aldosterone (5HT3) for relieving global IBS symptoms (NOT CONSTIPATION)
6. probiotics
7. lubiprostone C2 chloride channel activators, global symptoms in women with IBS-C or linaclotide for nausea
8. TCA antidepressants in relieving global symptoms and reduce abdominal pain

Question 11

What types of psychological treatments could be recommended to address IBS?

Answer 11

cognitive behavior therapy
dynamic psychotherapy
hypnotherapy

in treating global symptoms of IBS

Question 12

IBS is clinically indistinguishable from what other common GI disease?

Answer 12

celiac’s disease (always check TTIgA to rule out)