IBS

Question 1

Define IBS?

Answer 1

Irritable bowel syndrome, altered gut and enteric nervous system function without structural abnormalities. Luminal distention and visceral hypersensitivity key stimulus for symptoms

Question 2

Aetiology?

Answer 2

Not fully understood: Mixture of biological: altered brain/gut function, altered mobility/microbiota, hypersensitivity, antibiotics and physical factors:stress, childhood trauma.

Question 3

Pathogenesis?

Answer 3

Altered rectal perception. Luminal distention and visceral hypersensitivity key stimulus for symptoms

Question 4

Diagnosis?

Answer 4

Supportive vs red flag symptoms: infrequent stools (3 rule), bloating, abnormal stool form, straining/feeling of incomplete, urgency. Anaemia, inflammatory markers, abnominal/rectal mass, unintentional weight loss, rectal bleeding, family history, change to loose stool (6/52, >60)

Question 5

Blood tests?

Answer 5

IBS diagnostic criteria to exclude other diagnoses (FBC, ESR, CRP, EMA or TTG)

Question 6

Types? Stool chart?

Answer 6

IBS-C/M/D/U, Bristol stool chart: types 1-7 1 hard lump, 7 watery

Question 7

Management of IBS?

Answer 7

Diet and lifestyle, medications (probiotics) theraphy

Question 8

Impact on nutritional status?

Answer 8

Nutritional deficiencies due to avoiding certain foods (calcium intake)

Question 9

Nutritional assessment?

Answer 9

A: weight, height, WT changes
B: iron, folate, B12, coeliac screen
C: diagnosis, relevant investigations, medications, symptoms affecting nutrient intake
Identify: type
D: diet history (allergies, intolerances, adequacy) consider milk, fibre, fatty foods, fluid, caffeine and alc
E: meal pattern, social situation, lifestyle issues, psychological issues, timing of symptoms, time for exercise and relaxation, barriers to change

Question 10

Aims of treatment?

Answer 10

Manage symptoms, ensure balanced diet, 1st and 2nline advice

Question 11

1st line dietary advice?

Answer 11

Regular meal pattern, good eating lifestyle, 8 cups of fluid, limit caffeine 3-4 cups/alcohol 1-2 units, exercise, 5 portions of veg

Question 12

2nd line?

Answer 12

Linseeds (C), probiotics, D and M: avoid sorbitol, limit high fibre foods, reduce intake of resistant starch, limit fresh fruits, reduce short chain fermentable CHO’s
For bloating; increase oats, reduce wheat bran, reduce resistant starch, reduce ferm. Cho

Question 13

3rd

Answer 13

Elimination diets

Question 14

FODMAPs?

Answer 14

fermentable oligosaccharides disaccharides mono- and polyols. Poorly absorbed, osmotic and rapidly fermented. Restriction up to 8 weeks

Question 15

Monitoring and evaluation?

Answer 15

Anth, symptom scales (VAS, Likert, Bristol), knowledge eval, patient feedback
Evaluate achievements against original aims

Question 16

Prevalance?

Answer 16

10-20%