Irritable Bowel Syndrome

Question 1

What is irritable bowel syndrome?

Answer 1

Chronic condition
Recurrent episodes of abdo pain assoc w bowel dysfunction for >6 mo of previous year.
Pain often relieved by defecation and sometimes accompanied by bloating.

No structural abnormalities/ organic pathology
IBS occurs in about 15% of the adult population

Question 2

Aetiology of irritable bowel syndrome?

Answer 2

• Multifactorial but unclear
• Believed to be disorder of altered GIT motility
• Inflammatory or immune system involvement

Question 3

Risk factors of irritable bowel syndrome?

Answer 3

• Mental health problems (physical/ sexual abuse; PTSD)
• Female
• Age <50yo
• Previous enteric infection
• Fam Hx

Question 4

Common signs and symptoms of irritable bowel syndrome?

Answer 4

• Abdominal discomfort/ pain (lower/ mid abdo)
• Change in bowel habits and stool consitency
• Bloating/distension
• Symptoms worse by eating
• Generally normal abdo examination

Question 5

Other signs and symptoms of irritable bowel syndrome? (less common)

Answer 5

• Urgency
• Tenesmus
• Mucous in stool

Question 6

Ix: Investigations (non-imaging) for irritable bowel syndrome?

Answer 6

Bloods
- FBC: normal (if anaemic/ raised→ think of other differentials)
- Anti-ttg IgA test (negative)
- U&Es
- LFTs
- CRP

Pregnancy test

Stool sample
- Faecal occult test: normal (if raised→ could be IBD/ colorectal cancer)
- Faecal calcoprotectin: may be used to differentiate IBD from IBS (<50 micrograms/g makes IBS more likely)
- Stool microscopy

Question 7

Ix: What is the anti-ttg IgA test?

Answer 7

Test for coeliac disease

Question 8

Ix: Imaging investigations done for suspected irritable bowel syndrome?

Answer 8

Abdo XR: normal

Colonoscopy: normal; mucosal inflammation/ ulceration suggests IBD

Question 9

Management for irritable bowel syndrome? (4 main types)

Answer 9

Dietary and lifestyle modification

Symptomatic treatment:
- Abdo pain: antispasmodic (Buscopan)
- Laxatives for constipation

Tricyclic antidepressants and SSRIs
- Can help regulate abnormal bowel functions like diarrhea, constipation, and other symptoms.
- TCAs help with diarrhoea
- SSRIs help treat constipation

CBT