IBS Flashcards
Which population groups are more likely to get IBS?
10-20% of population
Peaks in 30s and 40s.
More females than males
What are the 3 types of IBS?
IBS-D (diarrhoea)
IBS-C (constipation)
IBS-M (mixed)
What is visceral hypersensitivity?
experience of pain within the inner organs (viscera) at a level that is more intense than normal. Hallmark characteristic of IBS found in 60% of suffers.
Peripheral sensation: inflammatory mediators up-regulate sensitivity.
Central sensation: more active spinal nerves
What are the characteristic symptoms of IBS?
Stomach pain/cramps due to high amplitude propagating contractions or exaggerated gastrocolic reflex pain Constipation Diarrhoea Bloating Nausea Lack of energy Mucus in faeces
What causes IBS?
Genetics and environment
What are the signs of visceral hypersensitivity?
Peripheral sensation = onset following gastroenteritis
Central: more radiation of the pain
What is the Rome IV criteria for diagnosis of IBS?
Recurrent abdominal pain on average 1 day a weeks for the last 3 months, associated with ≥2 of the criteria below. Symptoms onset 6 months prior to diagnosis.
1) Improvement, worsening or continuation of symptoms on deification
2) Onset associated with a change in stool frequency
3) Onset associated with a change in stool form
What other conditions is IBS associated with?
Fibromyalgia Chronic fatigue syndrome TMJ dysfunction Chronic pelvic pain 50% are depressed/anxious
How are IBS patients identified?
Change in bowel habit, nocturia, diet, trigger factors (infection, menstruation, drugs)
Opiate use (can worsen pain and constipation), Canabinoid use,
Psychological factors
What investigations should you consider to rule out other pathologies so you can make a positive diagnosis of IBS?
FBC, plasma viscosity, CRP, serology for coelics disease, colonoscopy if alarm symptoms
What are the dietary treatments for IBS?
Regular meal times
Reduced fibre intake (then increase agin over a month)
FODMAP
Gluten free diet?
What are the pharmacological treatments for IBS?
Stop opiate analgesics
anti-diarrhoea medication- Loperamide
Anti-spasmodics(modulate stretch receptors)- buscopan
Anti-depressants- amitriptyline (improves sleep and diarrhoea
What is the first line dietary advice for IBS patients?
£ regular meals per day Limit alcohol intake to 2 units per day Increase fluid intake Limit caffeine intake Limit fizzy drinks Cut down on fatty and processed foods Relax Limit fresh fruit to 3 portions a day Food and symptom diary ? Trial probiotics for 4 weeks ?Check food intollerances ?Aviod polyols
How long does it take for food to give you symptoms?
4-36 hours
When may a trial of probiotics be mre useful?
If there IBS was triggered by a GI infection or they are on lots of antibiotics
What is the second line dietary advice for IBD
Low FODMAP diet.
These are a group of short chain carbohydrates which are poorly absorbed leading to fermentatin and osmotic changes in the bowel
What does FODMAP stand for?
Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols
How doe FODMAP foods lead to the symptoms of IBS
Aren’t absorbed in the small intestine (they should be) this draws water into the gut => diarrhoea.
All the bacteria in the colon => fermentation and gas production
How long should people follow a low FODMAP diet for?
4-6 weeks. Its a diagnostic tool, not a long term solution.
You then reintroduce each dietary element one by one to identify triggers and tolerance levels
How successful is low FODMAP diet?
75% (Good)
Needs to be explained well by a specialist and the patient must have good compliance. Provide recipies
