IBS Flashcards
What are the risk factors for IBS development ?
- Young < 45
- Female
- Fam history of IBS
- Has a mental disorder or history of physcial/sexual abuse - e.g. anxiety, depression, or a personality disorder
What is the clinical criteria of symptoms which are used to help diagnose IBS ?
If the patient has abdo pain/discomfort that is either relieved by defaecation or is associated with altered bowel frequency/stool form for ≥ 6 months.
This should be accompanied by ≥ 2 of the following:
- Altered stool passage (straining, urgency, incomplete evacuation)
- Abdo bloating - distension, tension or hardness
- Symptoms made worse by eating
- Passage of mucus
Note - altered stool form may be constipation, diarrhoea or mucus
What additional features may support a diagnosis of IBS ?
- Lethargy
- Nausea
- Backache
- Bladder symptoms
What red flag symptoms should you ensure someone with possible IBS does not have and what should be done if so ?
- Rectal bleeding
- Unexplained/unintentional weight loss
- Family history of bowel or ovarian cancer
- onset after 60 years of age (as cancer more likely now)
- Raised inflam markers - suggestive of IBD
Basically screen for cancer symptoms and IBD, if they do have any then send for further investigation such as endoscopy & H+ breath test etc
What inital investigations should you do for someone with possible IBS to rule out other potential diagnoses ?
- FBC
- Inflam markers - ESR & CRP to rule out IBD
- IgA-TTG or IgA-EMA to rule out coeliacs disease
What is the diagnosis of IBS made on the basis of ?
If someone meets the clinical criteria of IBS & other potential diagnoses have been ruled out (IBD & coeliacs) & they have no red flags of cancer needing further investigation
Over what age is a diagnosis of IBS unusual ?
>50
What general dietry advice is given to people with IBS ?
- Have regular meals and take time to eat
- Avoid missing meals or leaving long gaps between eating
- Drink at least 8 cups of fluid per day, especially water
- Restrict tea and coffee to 3 cups per day
- Reduce intake of alcohol and fizzy drinks
- Consider limiting intake of high-fibre food e.g. wholemeal or high-fibre flour and breads, cereals high in bran, and whole grains such as brown rice
- Reduce intake of ‘resistant starch’ often found in processed foods
- Limit fresh fruit to 3 portions per day
- For diarrhoea, avoid sorbitol
- For wind and bloating consider increasing intake of oats e.g. oat-based breakfast cereal or porridge and linseeds
- For bloating/pain (brassicas, pulses, onions, garlic, mushrooms) ferment = gas = bloating/pain
If someone with IBS needs to increase their dietry fibre then what should be used ?
Soluble fibre supplements e.g. ispaghula (fybogel)
What is the 1st line pharmacological management of IBS ?
- 1st line for pain = antispasmodic agent e.g. buscopan, meberverine, alverine citrate, peppermint oil
- 1st line for contipation = laxatives e.g. polyethylene glycol, MgOH
- 1st line for diarrhoea = loperamide
What is peppermint oil also good for besides pain ?
Decreasing bloating
What laxatives should be avoided in IBS ?
Lactulose and stimulant laxatives e.g. senna, ducloax
What is the 2nd line option for contipation in IBS when previous laxatives have not helped & the patient has had constipation for 12 months ?
Linaclotide
If laxatives, loperamide or anti-spasmodics have not worked what are the 2nd line pharmacological options for IBS ?
- 1st line = tricyclic anti-depressant (TCA) e.g. amitriptyline or nortriptyline
- 2nd line = SSRI only if TCA ineffective
What is the 3rd line option in the management of IBS and when is it used?
CBT, hyponetherapy &/or psychological therapy for those who do not respond to pharmacological treatment s after 12 months
