IBS

Question 1

Definition

Answer 1

Considered a disorder of GI motility. Chronic condition characterised by abdo pain associated with bowel dysfunction relieved by defecation but no structural abnormalities.

Question 2

Prevalence & patient demographics

Answer 2

F>M, unusual for onset of symptoms after 50yrs, 15% of adult population

Question 3

Causes

Answer 3

Psychological
Genetic
Immune
Dietary
Intestinal microbiota may play a role
Stress/emotion TRIGGERS

Question 4

Risk factors

Answer 4

Physical & sexual abuse
Age <50yrs
Female
Previous enteric infection
Family &amp; job stress

Question 5

Clinical presentation

Answer 5

Abdominal discomfort/pain (better when defecated), abdo bloating/distension, mucus in stool, altered bowel habits associated with pain

Question 6

Differentials

Answer 6

Crohn’s, UC
Coeliac Disease
Lymphocytic & collagenous colitis
Colon cancer
Bowel infections

Question 7

Investigations

Answer 7

Stool studies
Bloods: FBC, anti-endomysial ab, anti-tTG ab
Plain abdo x-ray, flexible sigmoidoscopy, colonoscopy

Question 8

Management

Answer 8

CONSTIPATION: lifestyle & dietary modifications, laxatives, lubiprostone
W/pain-bloating: Above, antispasmodics, SSRI, Linaclotide, CBT/ hypnotherapy
DIARRHOEA: Lifestyle & dietary modifications, antidiarrhoeals W/pain-bloating: Above, antispasmodics, tricyclic antidepressants, CBT
ALTERNATING: Lifestyle & dietary modifications, laxatives, loperamide W/pain-bloating: Above, Antispasmodics, tricyclic antidepressants/SSRI, CBT/hypnotherapy

Question 9

Complications

Answer 9

Diverticulosis, damage to family/work relationships