IBS & IBD

Question 1

IBS (Irritable bowel syndrome)

Answer 1

Overview
Triggers: Stress, Anxiety, Alcohol, Spicy/fatty foods.

Symptoms: ABCD - Abdo pain, Bloating, Constipation (can alternate with diarrhoea), Diarrhoea, Flatulence, Passing mucus.
- Symptoms worsen by eating and relieved by defaecation.

NO specific cause. it Chronic long term condition.
- Affects age 20-30 yrs. MORE common in women.

Question 2

IBS Treatment

Answer 2

NON drug Treatment of IBS
- Diet and lifestyle changes.
- More physical activity, eat regular meals.
- Limit fresh fruit consumption
- Increase in SOLUBLE fibres (oats, sterculia, Ispaghula husk)
AVOID insoluble (e.g, bran)
- Increase water intake

Drug treatment of IBS
Severity dependent many are OTC.
- Antispasmodics & Antimuscarinics for abdo pain or spasms (Mebeverine, hyoscine butylbromide, Peppermint oil)
- Laxative and increase fibre for Constipation (AVOID lactulose it causes bloating)
- Linaclotide - Reduces pain, bloating, constipation. Used for moderate to severe IBS with constipation.
- Loperamide - for Diarrhoea.
- Peppermint oil - Bloating
- Antidepressants - TCA and SSRi when others FAIL.
- CBT - Cognitive therapy.

Question 3

IBD (Inflammatory bowel disease)

Answer 3

Overview
Causes:
- Autoimmune - body fights itself.
- Smoking, Stress, Anxiety, Infection, Air pollution, Drugs, Diet, Genetics, Environmental triggers.

They trigger immune response which causes inflammation:
- WHOLE GI = Chron’s
- COLON only = UC

BOTH are long term condition which involve inflammation in the GI tract.

Chron’s SYMPTOMS
- Abdo pain
- Diarrhoea
- Rectal bleed
- Fever
- Weight loss
- Anal fissure

COMPLICATIONS Crohn’s:
- Stricture (narrowing of GI tract) - Harder to pass food
- Perforation (Holes) - GI leaking or abdo abscess.
- Fistula - Abnormal connection between 2 body parts.
- Cancer
- Malnutrition
- Anaemia
- Growth failure/Delayed puberty
- Osteoporosis
- Arthritis
- Joint abnormalities

Complications (UC)
- Colorectal cancer
- Secondary osteoporosis
- VTE
- Toxic megacolon

Question 4

IBD Treatment

Answer 4

NON DRUG
- Diet change
- Stop smoking
- Stress management

DRUG
Symptomatic -
Loperamide, codeine for diarrhoea.
Chron’s diarrhoea can also use colestyramine if have no colitis.
NOTE: Antidiarrheal contraindicated in Acute UC.

Macrogol laxative - Constipation with UC

Refer to PHONE TABLE for main drugs. (NOT HIGH weight so dont need to know in detail just briefly)

NOTE: Proctitis - Rectum only
Proctosigmoiditis - Rectum and sigmoid colon.
Distal colitis - Left side of colon
Extensive colitis - Left + top
Pancolitis - WHOLE colon
Backwash ileitis - WHOLE + Distal ileum.

Question 5

Fistulating Crohn’s disease (BNF)

Answer 5

Asymptomatic treatment sometimes not needed.
Symptomatic may need local drainage and surgery.

Metronidazole or Ciprofloxacin alone or combo can help symptoms but complete healing is rare.
- Metronidazole used for 1 month - not >3 due to risk of peripheral neuropathy.

Azathioprine or Mercaptopurine - to control inflammation in Fistulating Cd. They also used for maintenance.

ALT is Infliximab.
- May need abscess drainage, fistulotomy and seton insertion b4 infliximab use.

Azathioprine, mercaptopurine, or infliximab should be continued as maintenance for minimum 1 year.

Question 6

Drugs Info

Answer 6

**Amino salicylates*
Sulfasalazine - Older 5 ASA with more AEs (stains contact lenses)
Newer 5 ASA - Mesalazine, Balsalazide, Olsalazine (Less AEs)

• Bone marrow suppression (condition where bone marrow dont make enough RBC [anaemia], WBC [neutropenia] or platelets [Thrombocytopenia]) - REPORT Unexplained bleeding, Bruising, Sore throat, Fever, or malaise (GPHC Q)
• Can do Orange/Yellow staining of bodily fluids (GPHC Q)

Monitor:
- Do FBC and STOP using if any blood dyscrasia sus.
- Renal function before at 3 months then annually.

Yellow/Orange bodily fluids with Sulfasalazine.
OTHER AEs:
- Nephrotoxicity
- Salicylate hypersensitivity