IBS Flashcards
what are the worrying signs of functional gut disorders (poor prognosis)?
patient in wheelchair due to pain
patient given up work due to pain
partner given up work to look after patient
patient wears dark glasses
patient carries water everywhere and drinks during interview
what is IBS?
chronic relapsing problem abdo pain bloating change in bowel habit 10-20% population (peak in 30s-40s) females>males
what is the pathophysiology of IBS?
genes + environment
disturbed GI motility; high amplitude propagating contractions - exaggerated by gastro-colic reflex, pain
visceral hypersensitivity
what is visceral hypersensitivity?
seen in 2/3rds patients
peripheral sensitisation
- inflammatory mediators up regulate sensitivity of nociceptor terminals
central sensitisation
- increased sensitivity of spinal neurones
how is peripher hypersensititvy evidenced?
up to 20% recall onset after infectious gastroenteritis
how is central hypersensitivity evidenced?
increased pain radiation
what is rome III criteria?
recurrent abdopain/discomfort for 3 days per month for 3 month + 2 or more of
- improvement/worse with defecation
- onset assoc with change stool frequency
onset assoc with change in stool form
what other clues can indicate IBS?
bloating
urgency
sensation of incomplete emptying
what illnesses is IBS associated with?
fibromyalgia chronic fatigue TMJ dysfunction chronic pelvic pain overlap causes more more sever IBS, psychiatric problems
how common is psychiatric problems in IBS?
50%
what is the best way to identify IBS?
history
- bowel habit
- bloating, nocturia
- diet (bread, fibre, meal times)
- trigger factors (infection, menstruation, drugs)
- opiate use (codeine and opiate/narcotic bowel syndrome)
- psychosocial factors (stress)
- underlying fears (cancer)
what are the alarm features of IBS?
age >50 ahort duration of symptoms woken from sleep rectal bleeding weight loss anaemia family history of colorectal cancer recent antibiotics (potentially C diff caused)
what are the investigations for IBS?
FBC
ESR/ plasma viscosity
CRP
antibody testing for coeliac disease (TTG)
lower GI testing if >50 or strong family history of colorectal cancer
how is IBS managed?
diet - regular meal times - reduce fibre - FODMAP/GFD drugs - stop opiates - anti-diarrhoeals - anti-spasmotics - anti-depressants
what is the relationship between fibre and IBS?
suggestion that low fibre diet improves symptoms