IBS Flashcards
When would you consider assessment for IBS?
Patient reports having any of the following symptoms for at least 6 months (ABC):
• Abdominal pain or discomfort
• Bloating
• Change in bowel habit
What symptoms and signs support the diagnosis of IBS?
Colicky abdominal pain or discomfort that is:
• Relieved by defecation
• Associated with altered bowel frequency
And 2 of the following:
• Altered stool passage (straining, urgency, incomplete evacuation)
• Abdominal bloating, distention, tension or hardness
• Symptoms made worse by eating
• Passage of mucus
What other non-GI symptoms may support a diagnosis of IBS?
- Lethargy
- Nausea
- Backache
- Bladder symptoms
What tests would you do for IBS?
- FBC
- Coeliac serology (EMA or TTG)
- Faecal calprotectin
- CRP
What are the subtypes of IBS?
- Diarrhoea predominant (IBS-D)
- Constipation predominant (IBS-C)
- Mixed
What are the red flags for further investigations?
- > 60yrs
- Rectal bleeding
- Anaemia
- Weight loss
- Fam Hx colorectal cancer
- Abdominal/rectal mass
- Raised CRP/ESR or faecal calprotectin
What would you do if a woman >50 presents with persistent bloating?
Need to rule out ovarian cancer
• USS of ovaries
• Ca125 levels
What requires an urgent referral for screening for colorectal cancer?
- > 40 with unexplained abdominal pain and weight loss
- > 50 with unexplained rectal bleeding
- > 60 with changes in bowel habit or unexplained iron deficiency anaemia
How do you behaviourally manage IBS?
- Identify associated stress, anxiety, depression and manage appropriately
- Keep a food diary and look for any obvious food triggers
- Encourage physical activity
- Probiotics for at least 4 weeks
- Low FODMAP diet
How do you behaviourally manage IBS-D?
o Reduce fibre intake
o Reduce caffeine, alcohol, carbonated drinks and gas-producing foods
How do you behaviourally manage IBS-C?
o Fibre supplements (ispaghula) or foods high in solute fibres (oats)
For constipation, what pharmacological treatment would you give?
Laxatives
What are bulk-forming laxatives?
Retain fluid within the stool and increase faecal mass, stimulating peristalsis and have stool-softening properties
Give examples of bulk-forming laxative
- Ispaghula husk (Fybogel)
- Methylcellulose
What are osmotic laxatives?
Increasing amount of fluid in the large bowel producing distention, which stimulates peristalsis
Give examples of osmotic laxatives
- Lactulose (not recommended in IBS)
- Macrogols
- Phosphate and sodium citrate enemas
What are stimulant laxatives?
Cause peristalsis by stimulating colonic nerves (senna) or colonic and rectal nerves (bisacodyl, sodium picosulfate)
What are Prokinetic laxatives?
Prucalopride -> 5HT4 receptor agonist, which stimulates intestinal motility
What would you give to a patient who has had constipation for >12 months and has received optimal doses of laxatives from different classes?
Linaclotide
- 290 microgram capsules 30 mins before meals
For diarrhoea, what pharmacological treatment would you give?
o Loperamide 4mg, followed by 2mg for up to 5 days, dose to be taken after each loose stool; usual dose 6-8mg daily, max 16mg o.d
For abdominal pain, what pharmacological treatment would you give?
- 1st Antispasmodic drugs
- 2nd Low-dose tricyclic antidepressant
- 3rd SSRI
Give examples of a smooth muscle antispasmodic drug
- Mebeverine (colofac)
- Alverine (spasmonal)
- Peppermint (colpermin)
Preferred to anticholinergics as cause less SE
Give examples of an anticholinergic antispasmodic drug
- Dicycloverine (merbentyl)
- Hyoscine (buscopan)
- Propantheline (probanthine)
Give examples of TCA drug
Amitriptyline
Give examples of SSRI drug
- Citalopram
- Fluoxetine
