IBS

Question 1

Define IBS

Answer 1

chronic condition characterized by abdomen pain that is relieved by defecation, or associated with altered stool form or bowel frequency (constipation and diarrhoea my alternate) and there are >/= to 2 for at least 3 months of: • Urgency• Incomplete evacuation (tenesmus)• Abdominal bloating/distension• Mucous PR• Worsening of symptoms after food

Question 2

What are the patterns of IBS?

Answer 2

constipation-predominant, diarrhea-predominant, pain predominant or mixed pattern

Question 3

What are the main DDx of IBS?

Answer 3

• Coeliac disease• IBD (Crohn’s or UC)• Colorectal cancer (in 45 + year old) • Bowel infection especiallyGiardia lamblia

Question 4

How is IBS diagnosed? d

Answer 4

1. Typical clinical history as in definition of IBS 2. Exclude other diagnoses Presence of “red-flag” symptoms or signs such as • Weight loss• Rectal (PR) bleeding• Nocturnal symptoms, and • Age >45 should prompt further investigation before a diagnosis of IBS is made

Question 5

What are the GIT red flags?

Answer 5

• Weight loss• Rectal (PR) bleeding• Nocturnal symptoms, and • Age >45 should prompt further investiagtion before a diagnosis of IBS is made

Question 6

What are the dietary modifications that can be made for mgmt of IBS?

Answer 6

• Avoiding common food triggers – FODMAPS• Avoiding caffeine, alcohol, smoking

Question 7

What are FODMAPS?

Answer 7

• FODMAP: poorly absorbed fermentable carbohydrates• Malabsorption of these sugars leads to fermentation by bacteria in the colono Hydrogen/methane gas leading to distensiono Osmotic diarrheao Triggering of IBS symptoms• A low FODMAP diet is now the 1st line treatment for IBS• Hydrogen/methane breath testing is available to test for lactose and fructose malabsorption