IBS

Question 1

“Alarm features” of GI upset

Answer 1

fever, weight loss, bloody stools, refractory diarrhea, family hx of ovarian or colon cancer, hx of celiac, or IBD

ask for these before diagnosing IBS…these usually point to underlying pathology

Question 2

Environmental and host factors that may contribue to IBS

Answer 2

environmental - hx of abuse/stressors, food intolerance, enteric infections, antibiotic use

host - altered gut permeability, gut immune hyperactiivty, altered gut flora, altered gut pain sensitivity, dysregulation of brain-gut axis during stress

Question 3

IBS usually occurs with what other diseases

Answer 3

fibromyalgia, chronic headaches, lower back pain

Question 4

Typical presentation of IBS

Answer 4

Woman, 20-30 years old
predominant pattern of constipation, diarrhea, alternating diarrhea/constipation or periods of normal bowel habits that alternate with either diarrhea/constip/both….usually presents with crampy abd pain (location varies) that is relieved by defecating

Question 5

What criteria is used to diagnose IBS?

Answer 5

Rome III criteria

Question 6

ROME III criteria

Answer 6

recurrent abd pain/discomfort for at least 3days/month for the past 3 months with at least 2 of the following

• improvement with defecation
• change in shape/form of stools
• chang ein frequency of stools

criteria fulfilled for the previous 3 months with symptom onset at least 6 months ago

Question 7

What labs to draw when evaluating IBS

Answer 7

• CBC, age approp colon cancer screening
• (in cases with diarrhea/mixed subtype), CRP and celic (igA tissue transglutimase antibody or antiendomysial antibody))
• can also test for bile malabsorption
• CA-125 in pt with family hx of ovarian cancer

Question 8

Treatment options for IBS with abdominal pain

Answer 8

• antisapasmodic (dicyclomine or hyoscyamine) prn (first line for abdoinal pain)
• low dose TCA or SSRI when comorbid with depression/anxiety or if pain is very severe
• rifaximin; as long as pt DOES NOT have constipation
• probiotics/peppermint oil

Question 9

Treatment options for IBS with constipation predominant

Answer 9

• soluble fiber (dietary, synthetic, or naturla)
• polyethylne glycol
• lubiprostone (activates intestinal chloride channels and increases fluid secretion
• linaclotide - increases motility and fluid secretion (expensive)

Question 10

Treatment options for IBS with diarrhea predominant

Answer 10

• loperamide (imodium)
• rifaximin; used for traveler’s diarrhea, bacteriostatic gut specific
• alosetron - severe diarrhea of at least 6 months

Question 11

What treatment is common to all subtypes and patients with IBS

Answer 11

behavioral therapy and lifestyle modifications!!!! patient’s mental state actively influences symptom