IBS Flashcards
What is the Rome Diagnostic criteria for IBS?
- recurrent abdominal pain/discomfort for 3 days of the month
Assoc. with:
- improves with defecation
- change in stool freq.
- change in form/appearance of stool
If a patient presents with symptoms of IBS, what other criteria would make you investigate further?
Further evaluation if >50 or has any of:
- weight loss - blood in stools - anaemia - fever - short history of progressive pain
What is involved in the Manning criteria for IBS?
- pain relieved on defecation
- more freq. and looser stools at onset of pain
- visible bloating/ abdominal distension
- passage of mucus
- tenesmus (feels incomplete)
What investigations would you consider doing for patients who present with symptoms of IBS?
- inflammatory markers (PV/ CRP)
- TTG (coeliac)
- faecal calprotectin
- AXR in selected people
- H+ breath test
- cross sectional imaging
What dietary measures are recommended for the treatment of IBS?
- healthy intake of fruit and vegetables
- skins and seeds may irritate symptoms
- Some foods may ferment gas/ bloating/
pain (e.g. pulses, onions, garlic, mushrooms) - If it upsets you, don’t eat it
Give examples of antispasmodics which can be used in IBS?
- Mebeverine (Colofac)
- Alverine citrate (Spasmonal)
- Peppermint oil (Colpermin) - decreases bloating
How is fibre added to the diet in patients experiencing IBS?
- bran fibre often ineffective
=> soluble fibre supplements effective:
E.g. ispaghula (Fybogel)
- absorb water to bulk up stool
Osmotic laxatives do not help symptoms of pain in IBS. TRUE/FALSE?
TRUE
- prevents water absorption
- improves constipation but not pain
Stimulant laxatives should be avoided in IBS patients/ TRUE/FALSE?
TRUE
- avoid
- only infrequent short term use
What anti-diarrhoeals can be used in IBS?
loperamide
- reduces stool frequency - improves consistency
codeine phosphate
- effective - should be avoided if dependence
What antidepressants can be used in IBS?
- tricyclics (amitriptyline, nortriptyline)
- SSRI’s
What anti-convulsant analgesics can be used in IBS?
gabapentin
pregabalin (beneficial in anxiety component)
Why are pro-biotics thought to be useful in IBS?
- to alter the gut microbiota
What psychological and alternative therapies can be used for IBS treatment?
- CBT
- dynamic psychotherapy
- hypnotherapy
- Herbal remedies
- acupuncture