IBS

Question 1

Define:

Answer 1

•	A functional bowel disorder defined as recurrent episodes of abdominal pain/discomfort (in the absence of detectable organic pathology) for > 6 months of the previous year, associated with two of the following:
o	Altered stool passage 
o	Abdominal bloating 
o	Symptoms made worse by eating 
o	Passage of mucous

Made better on defecation

Question 2

Aetiology/risk factors:

Answer 2

• UNKNOWN
• Could be visceral sensory abnormalities, gut motility abnormalities, psychosocial factors (e.g. stress), food intolerance (e.g. lactose) and many more
• IBS is usually a diagnosis of exclusion
• Can be divided into constipation-predominant, diarrhoea-predominant or mixed IBS

Question 3

Epidemiology:

Answer 3

• COMMON
• 10-20% of adults
• More common in females (2:1 ratio)

Question 4

Symptoms:

Answer 4

• 6+ months history of abdominal pain
o Pain is often colicky
o It is in the lower abdomen
o Relieved by defecation or passing of flatus
• Altered bowel frequency (> 3 motions per day or < 3 motions per week)
• Abdominal bloating/distension
• Change in stool consistency
• Worsening of symptoms after food
• Passage with urgency or straining
• Tenesmus
• Other symptoms: nausea, bladder symptoms, back ache
• Symptoms are CHRONIC and exacerbated by stress, menstruation or gastroenteritis (post-infection IBS)
• MAKE SURE YOU SCREEN FOR RED FLAG SYMPTOMS:
o History < 6 months
o Weight loss
o Anaemia
o PR bleeding
o Late onset (> 60 yrs)

Question 5

Signs:

Answer 5

• Usually NORMAL on examination

* Sometimes the abdomen may appear distended and be mildly tender on palpation in one or both iliac fossae

Question 6

Investigations:

Answer 6

• Diagnosis is mainly from the history but organic pathology must be excluded
• Blood: FBC (anaemia), LFT, ESR, CRP, TFT, anti-endomysial/anti-tranglutaminase antibodies (coeliac disease)
• Stool examination: microscopy and culture for infective cause
• Ultrasound: exclude gallstone disease
• Urease breath test: exclude dyspepsia due to Helicobacter pylori
• Endoscopy: if other pathologies suspected

Question 7

Management:

Answer 7

• Advice: dietary modification – fibre, lactose, fructose, wheat, starch, caffeine, alcohol, fizzy drinks may worsen symptoms
• For constipation: increase soluble fibre, bisacodyl and sodium picosulfate
• Medical: depends on the main symptoms affecting the patient
o Antispasmodics (e.g. buscopan) – for colic/bloating
o Prokinetic agents (e.g. domperidone, metaclopramide)
o Anti-diarrhoeals (e.g. loperamide) – for diarrhoea
o Laxatives (e.g. senna, movicol, lactulose) – for constipation
o Low-dose tricyclic antidepressants (may reduce visceral awareness) – for psychological symptoms/visceral hypersensitivity
• Psychological therapy:
o CBT
o Relaxation and psychotherapy

Question 8

Complications:

Answer 8

• Physical and psychological morbidity

* Increased incidence of colonic diverticulosis

Question 9

Prognosis:

Answer 9

• Chronic relapsing and remitting course of disease

* Often exacerbated by psychosocial stresses