IBS

Question 1

What lifestyle and diet advise can be given for these pts?

Answer 1

Increase physical activity, eat regulalry without missing meals or leaving long gaps between meals, limit fresh fruit to no more than 3 a day. Reduce insoluble fibres and resistant starches, drink lots of fluid and reduce fizzy drink, caffeine and alcohol content.

Question 2

What laxative may not be recommended due to its bloating effect which can exacerbate IBS?

Answer 2

Lactulose

Question 3

What laxative can be used if a pt has used many different laxatives of different classes but still suffering from constipation for over 12 months?

Answer 3

Linaclotide

Question 4

If antispasmodics, antimotility or laxatives does not alleviate ab pain or discomfort what else can be tried?

Answer 4

Low dose TCA (unlicensed) or SSRI if that fails (unlicensed)

Question 5

What is the MOA of antimuscarinics in IBS? and what SE can you expect

Answer 5

Prevents stimulation of parasympathetic pathway to reduce smooth muscle tone and peristaltic contractions. SE:tachycardia, dry mouth, constipation.