IBS Flashcards
IBS is more common in F/M
is characterised by:
Females 2:1
chronic, relapsing abdo pain/discomfort
bloating
change in bowel habit
In 2/3rds of patients the pathophysiology of IBS is due to ____
1) ___ sensitisation
2) ___ sensitisation
visceral hypersensitivity
peripheral and central sensitivity
20% of peripheral sensitisation in IBS patients is due to
previous infectious gastritis - inflam. mediators upregulate nociceptor terminals in gut
central sensitisation in IBS is due to __
increased sensitivity of spinal neurones
causes increase in pain which radiates to somatic structures
Rome III criteria for IBS
recurrent abdo pain for more than/= 3 days/month for 3 months
+ more/= 2 of: improvement with defaecation, onset ass with change in stool form/freq
If symptoms improve with defaecation think
IBS
In a Hx of someone with IBS may see:
fibre worsens symptoms
dietary exclusions
triggers
opiate use
Investigations for IBS
FBC ESR (plasma viscosity) CRP TTG Ig (rule out coeliacs) lower GI test if suspect ca
Diet for IBS =
regular meals
low FODMAP then 6-8wks reintroduce restricted foods
low fibre
low tea coffee and sorbitol (if diarrhoea predom)
Anti-spasmodics used in IBS
mebeverine
hyoscine
anti-depressant that can be used to treat IBS
tricyclics eg. amitryptyline
decreases diarrhoea, afferents from gut, restores sleep pattern
give low dose at night
Treatments for IBS
stop opiates diet antispasmodics laxatives (PEG better than lactulose) anti-diarrhoeals - loperamide amitryptyline CBT, hypnosis etc
