Irritable Bowel Syndrome Flashcards
What are the symptoms?
Abdominal pain -worse on eating -relieved by defacation Abdominal bloating Fluctuating bowel habit Early morning urgency Feeling of incomplete emptying Gynae symptoms -dyspareunia -dysmenorrhoea -back pain
How can a diagnosis of IBS be made?
Normal test results
Either
- abdominal pain relieved by defacation
- abdominal pain with change in bowel habit
WITH at least 2 of the following
- abdominal bloating/hardness/tenderness
- mucous
- changes in passage of stool- urgency or straining
- symptoms worse on eating
How common is IBS?
10-20% prevalence
F:M >2:1
Onset <40yrs
What are the current theories regarding the pathophysiology of IBS?
Mixed group of abdo sx w/ no organic cause
Possible difference in ‘brain-gut’ axis, leading to increased visceral perception & decreased visceral pain threshold
What investigations are appropriate in suspected IBS?
CPR/ESR
Faecal calprotectin (exclude IBD)
TTG/anti-endomysial antibodies (exclude coeliac)
FBC (anaemia)
What are the ‘red flag’ sx in suspected IBS?
Unintentional wt loss Rectal bleeding FH bowel/ovarian cancer Change in bowel habit in >60yrs Incontinence Having to open bowels frequently at night
What are the management options in IBS?
Lifestyle measures -decrease weight Dietary advice (from dietician)- low FODMAP diet Antispasmodics Laxatives Medical management
What lifestyle measures should be taken to manage IBS?
Relaxation Exercise/diet Regular mealtimes Lots of water Limit tea/coffee High insoluble fibre food intake -3 portions fruit a day Decrease wholegrain food intake
What are the medical options for managing IBS?
Diarrhoea- loperamide
Constipation- avoid lactulose
-can give linaclotide if sx persisting for >1yr and max doses of other classes tried
TCAs if this fails
What is refractory IBS?
Sx persisting after >12mo of antidepressant medications
Refer for CBT
