IBS and functional GI disorders

Question 1

How are functional GI disorders defined?

Answer 1

variable combinations of chronic or recurrent GI symptoms not explained by structural or biochemical abnormalities

Question 2

Describe common clinical presentations of IBD

Answer 2

abdominal discomfort, altered bowel habits that can be diarrhea predominant, constipation predominant, or mixed
abdominal tenderness to palpation- visceral hypersensitivity
abnormal stool passage- rectal dissatisfaction
mucus in stool
bloating

Question 3

What are the criteria for a diagnosis of IBS?

Answer 3

abdominal pain or discomfort at least 3 days/ month for at least 6 months
+ 2 or more of:
improvement with defecation
onset associated with change in frequency of stool
onset associated with change in form of stool

Question 4

List alarm features that warrant a more significant evaluation

Answer 4

rectal bleeding
weight loss
iron deficiency anemia
nocturnal symptoms
family or personal history of colon cancer, IBD, celiac

Question 5

In evaluation of possible IBS, what patients should receive colonoscopy?

Answer 5

over 50 yrs or alarm features

Question 6

Patients with IBS-D or IBS-M should also be screened for:

Answer 6

celiac disease

Question 7

True or false: depression/ anxiety cause IBS

Answer 7

FALSE

but can amplify symptoms when IBS is presetn

Question 8

List inflammatory findings that are abnormal in patients with IBS

Answer 8

• higher lymphocyte count per ganglion
• more inflammation in myenteric plexus
• increased pro-inflammatory cytokines
• abnormal mast cells

Question 9

Many patients with IBS can relate the onset of their symptoms to:

Answer 9

a case of bacterial or viral gastroenteritis

Question 10

What factors increase the likelihood of IBS developing following a GI infection?

Answer 10

female
more severe diarrheal illness
bloody diarrhea during illness
losing > 10 lbs during illness

Question 11

Patients with IBS have increased ________, indicating the role of enteric nervous system pain fibers

Answer 11

visceral hypersensitivity

Question 12

The antidiarrheal agent loperamide is not more effective than placebo at reducing pain, bloating, or global symptoms of IBS, but it is an effective agent for the treatment of ________.

Answer 12

diarrhea

reduces stool frequency, and improving stool consistency.

Question 13

A nonabsorbable antibiotic _________ is more effective than placebo for global improvement of IBS and for bloating

Answer 13

rifaximin

Question 14

What are the down sides to using rifaximin to treat IBS?

Answer 14

expensive

patients may need to take very long term

Question 15

The 5-HT 3 receptor antagonist ______ may be effective at relieving global IBS symptoms in diarrhea.

Answer 15

alosetron

Question 16

Alosetron should NEVER be used to treat ________

Answer 16

constipation

Question 17

______ and _____ may be effective in treating global IBS symptoms and abdominal pain and much lower doses than usual

Answer 17

SSRIs and TCAs

Question 18

Though there is no proven benefit, many patients feel better when using _________ supplements such as psyllium and wheat bran

Answer 18

dietary supplemental fiber

Question 19

_______ drugs can function as anti-spasmodic agents in the gut and reduce pain and bloating

Answer 19

anticholinergics

ex dicylomine, hyocyamine

Question 20

The elective C-2 chloride channel activator lubiprostone is approved for use specifically in:

Answer 20

females with IBS-C

Question 21

What is the role of prokinetics like metoclopramide in IBS?

Answer 21

No proven benefit

Question 22

_____ is a 5-HT 4 receptor agonist that was used to reduce pain and bloating in IBS-C but was taken off the market

Answer 22

tegaserod

Question 23

Increase in _______ has also been shown to have a beneficial effect on IBS symptoms.

Answer 23

physical activity