IBS & PUD

Question 1

Risk factors of IBS? (5)

Answer 1

Previous gastroenteritis (20%, most accepted)

FH

Food intolerance

Psychiatric: somastisation disorder, anxiety, depression

History of physical/sexual abuse

Question 2

Management of IBS?

Answer 2

Non-pharmacological

• Education
• Insoluble High-fibre diet (psyllium [si.lee.uhm] aka. metamucil, ispaghula [ee.spagula]). Not soluble high-fibre - e.g. whea bran (no better than placebo)
• Low FODMAP diet (helpful in 50%)

Pharmacological

• Symptomaic: loperamide, laxatives
• Anti-spasmodic (e.g. mebeverine)
• TCA (NNT=4), SSRI

Question 3

How would you diagnose Zollinger-Ellison syndrome?

Answer 3

When peptic ulceration is in unusual location, resistant to therapy, ulcer relapse after operation or frequent recurence - suspect ZE.

Diagnosis is via fasting serum Gastrin: >300 pg/mL suggestive, >1000 pg/mL almost diagnostic.

Question 4

How would you manage & FU peptic ulcer disease fond on Gastroscopy?

Answer 4

Eradicate H.pylori (PPI+Amox+Clarithro)

Cease NSAIDs where possible, if ceassation not possible → continue PPI

Consider PGE1 analogue - Misoprostol (substantially reduces risk of NSAID induced PUD)

If symptoms are not relieved, repeat Gastroscopy to confirm healing and exclude carcinoma

In 1 month, confirm irradication of H.pylori by Gastroscopy (as above) or by Urea breath test