IBS

Question 1

What is the criteria called for diagnosing IBS?

Answer 1

Rome III criteria

Question 2

What is the Rome III criteria?

Answer 2

Recurrent abdominal pain or discomfort and a marked change in bowel habit for at least 6 MONTHS
Plus at least of two of:
- Pain relieved by bowel movement
- Onset of pain related to change in stool frequency
- Onset of pain related to change in stool

Question 3

Other clues IBS?

Answer 3

Bloating
Nocturia (excessive urination at night)
Sensitivity to particular foods (meal times, bread, fibre, bizarre exclusions)
Trigger factors (infection, menstruation)
Stressed/anxious individual
rule out narcotic bowel syndrome (opiates cause constipation)

Question 4

Symptoms are likely to be due to more serous disorders (not IBS), in …

Answer 4

older patients
watch out for anaemia, rectal bleeding , weight loss, FH colorectal cancer, short duration symptoms, woken up sleep due to bowel habit

Question 5

Investigations?

Answer 5

NO specific diagnostic test - clinical 
Test to rule out other stuff
- serological tests for coeliac disease
- full blood count
- CRP
- ESR/plasma viscosity

Question 6

Treatment?

Answer 6

Dietary and lifestyle
- avoid foods that precipitate symptoms
- Regulate dietary fibre and fluid intake (excess fibre can contribute to bloating + pain, too little causes constipation)
Antidiarrhoeals
Antispasmotics: spooth muscle relaxants
- serotonin receptor antagonists
Antidepressants, behavioural therapy, psychotherapy

Question 7

What is Loperamide?

Answer 7

Opiate analogue
acts as an anti motility drug
inhibits peristalsis and gut secretions
Helps with diarrhea
No effect on pain
NO dependency - doesn't cross blood brain barrier

Question 8

Disadvantages of using laxatives in IBS?

Answer 8

Bulk laxatives which contain fibre aggravate pain
Lactulose (osmotic laxative) promotes flatulance (farting alot)
CAN use stimulant laxatives such as senna, but only short term. Long term use can cause tachyphylaxis leading to constipation.

Question 9

T/F

Antispasmodics shown to improve symptoms IBS

Answer 9

F
poor quality studies
No benefit diarrhoea/constipation

Question 10

Mebeverine and Hyoscine are

Answer 10

antispasmodics

Question 11

Amitriptyline is a

Answer 11

Tricyclic - antidepressants

Question 12

Mechanism anti depressants in IBS treatment?

Answer 12

Reduce afferent signals gut

Help restore sleep pattern