IBS

Question 1

What is IBS?

Answer 1

a diagnosis of exclusion

functional disorder

Question 2

What is usual age of onset?

Answer 2

≥40

Question 3

What 3 features would make you suspect IBS?

Answer 3

1. Abdo pain
2. bloating
3. change in bowel habit

Question 4

What features would lead you to make a diagnosis of IBS?

Answer 4

Abdo pain related to any of:
- defecation 
- altered stool frequency 
- altered stool form + any one of
altered stool passage (straining, urgency)
bloating
sx worsened by eating
passage of rectal mucus
alternative conditions excluded

Question 5

When should u consider a diff diagnosis?

Answer 5

age >60 
Hx <6m
Anorexia
WL
Waking at night w pain/diarrhoea
Mouth ulcers
Abnormal ESR/CRP

Question 6

What tests

Answer 6

1. FBC, CRP, ESR, coeliac serology
2. Colonoscopy if ≤60yrs, or any marker organic disease - raised temp, WL, PR blood
3. Refer if FHx of organic or bowel ca
4. Exclude ovarian Ca w CA125
5. Stool culture, B12 folate, TSH, faecal calprotectin

Question 7

What would you want to exclude if the pain was cyclical?

Answer 7

endometriosis

Question 8

What is the management of constipation dominant IBS?

Answer 8

adequate water + fibre intake
promote physical activity
avoid insoluble fibre - bran
simple laxatives - avoid lactulose

Question 9

What is the management of diarrhoea dominant IBS?

Answer 9

Avoid sorbitol
Alcohol + caffeine reduced 
Reduce dietary fibre 
Avoid trigger foods 
Bulking agent +/- loperamide 2mg

Question 10

What is the management of colic and bloating?

Answer 10

antispasmodics - mebeverine. hyoscine
Low FODMAP diet
Probiotics can help flatulence and bloating

Question 11

What does FODMAP stand for?

Answer 11

fermentable oligosaccharides, disaccharides, monosaccharides and polyols, which are more commonly known as carbohydrates.
In essence, FODMAPs are different carbohydrates found in a wide range of foods including onions, garlic, mushrooms, apples, lentils, rye and milk.

Question 12

What are differentials of IBS

Answer 12

Malignancy
Constipation - functional, drug induced, hypothyroidism
Diarrhoea - IBD, coeliac, gastritis, abx associated, hyperthyroidism, laxative misuse
Pain/discomfort - diverticular disease, chronic pancreatitis, gallstones, peptic ulcer disease, GORD

Question 13

Give an example of a bulking agent

Answer 13

ispaghula husk