Irritable Bowel Syndrome Flashcards by Jordan Cyr

True or false: in the doctors office there is testing to show abnormalities to prove IBS

false
no tests, its a diagnosis of exclusion
the bowel looks fine, yet there are issues

How well did you know this?

Not at all

Perfectly

What is the old term for IBS?

spastic colon

How well did you know this?

Not at all

Perfectly

What percentage of people in the Western world suffer from IBS?

10-20%
more common: women in North America, men in Asia

How well did you know this?

Not at all

Perfectly

Where does IBS rank for lost days of work?

2nd only behind the common cold
only 15% of people seek medical care

How well did you know this?

Not at all

Perfectly

What is the etiology of IBS?

brain-gut axis–>emotional expression thru gut 5-HT
sufferers seem to “over-react” to various stimuli such as stress, diet (fructose, gluten, etc), certain activity
previous gut infection (eg TD)
linked with depression
no abnormalities on physical exam

How well did you know this?

Not at all

Perfectly

What are the symptoms of IBS?

> 6 months of duration
pain/spasms
-most common symptom, less severe post-BM
bloating/fullness
urgency
constipation<–>diarrhea
-IBS-C is most common type
mucous in stool (but no bleeding)
bloating/distention
-15-30% in general population, 75-90% in women

How well did you know this?

Not at all

Perfectly

What are the patterns of IBS?

IBS-D
->25% of BMs are 6 or 7 on Bristol
IBS-C
->25% of BMs are 1 or 2 on Bristol
IBS-mixed
patterns can change over time

How well did you know this?

Not at all

Perfectly

How many stools per week do IBS-D sufferers average?

18 stools/week
50% were watery

How well did you know this?

Not at all

Perfectly

True or false: simethicone will be a great add for IBS patients

false

How well did you know this?

Not at all

Perfectly

What are some other conditions to keep in mind when you are thinking a case might be IBS?

lactose intolerance
IBD
gluten intolerance
drug-induced
colorectal cancer
IBS is more common than all these

How well did you know this?

Not at all

Perfectly

What are some dietary changes an IBS sufferer can make?

fiber (mainly IBS-C, tiny bits on the IBS-D front)
reduce fatty foods
avoid offending foods

How well did you know this?

Not at all

Perfectly

What is the acronym to help remember the foods that might irritate an IBS patient?

FODMAP
fermentable
oligosaccharides (fructans, galactans)
disaccharides (lactose)
monosaccharides (fructose)
AND
polyols (sugar alcohols)

How well did you know this?

Not at all

Perfectly

What is the use of Beano?

prevent gas formation via beans + long chain carbs
adding an enzyme (a-d-galactosidase) to breakdown stuff and prevent gas
take before food
NOT FOR IBS

How well did you know this?

Not at all

Perfectly

What is the use of Lactaid?

breaks down sugars to prevent osmotic force and gas
milk, ice cream, etc
NOT FOR IBS

How well did you know this?

Not at all

Perfectly

What is often a critical non-pharm component of managing IBS?

the psychological angle
strong patient-physician relationship
many people with IBS have coexisting anxiety or depression

How well did you know this?

Not at all

Perfectly

Describe the use of bulk-forming agents in IBS.

psyllium is recommended for IBS-C
-2 to 4 tbsp with fluids
-start with 1 tbsp
PEG 3350 has less proof (likely to change)
might help with IBS-D too (stool consistency)
if this fails can use senna/bisacodyl for breakthrough

How well did you know this?

Not at all

Perfectly

True or false: using a bulk-forming agent for IBS-C will help with the spasms/pain

false
this is where the frustration comes in for patients

How well did you know this?

Not at all

Perfectly

How do smooth-muscle relaxants work for IBS?

create less spasm/better coordination
work best if used regularly (not prn)

How well did you know this?

Not at all

Perfectly

Which variant of IBS are smooth muscle relaxants best for?

can try in IBS-C or IBS-D

How well did you know this?

Not at all

Perfectly

What are examples of smooth muscle relaxants for IBS?

pinaverium
-calcium channel antagonist–>muscle relaxation
-selective for intestinal smooth muscle
trimebutine
-opiate receptor agonist/5 HT3 antagonist

How well did you know this?

Not at all

Perfectly

Which variant of IBS are anti-diarrheals used for?

IBS-D

How is loperamide used for IBS-D?

2-4mg up to QID
outcome=decreased diarrhea, no help for pain

True or false: years of use of loperamide for IBS-D is safe

true

Which anti-diarrheal has an increased risk for side effects and is therefore rarely used?

diphenoxylate

If someone has a fear that sudden urgency and need to defecate may occur in a setting where toilets are not available, what could be a good move?

take 2-4mg of loperamide approx 45 min ahead of time

True or false: if a patient has IBS-D, they will have that variant forever and will never experience IBS-C

false patterns can change in same patient over time

Describe the use of peppermint oil for IBS.

mildly effective smooth muscle relaxant -can be tried for IBS-C or IBS-D "for pain, spasms, bloating, gas" enteric caps *try for one month, have low expectations*

What is IBgard?

medical food specially formulated for the dietary management of IBS contains ultra purified peppermint oil

What might be a good Rx option for an IBS-D patient who also experiences depression?

TCAs for pain/diarrhea -amitriptyline or desipramine at lower doses -anti-cholinergic=constipation

Are SSRIs used for IBS?

can be recommended if IBS+depression but unclear benefits -would be for IBS-C -better for depression can be helpful in short-term, but ideal to stop prolonged use

How much of the bodys serotonin is produced in the gut?

90%

What is alosetron?

5 HT3 antagonist-->decreased gut motility for IBS-D women only (decreased diarrhea/pain) d/c in 2001 because of severe constipation-->ischemic colitis

What is tegaserod?

5-HT4 partial agonist-->prokinetic agent IBS-C and abdominal pain in women main se=diarrhea (12%) d/c in 2007 (cardiac risk)

What are all the options we have for IBS-D only?

loperamide bulk-forming lax buscopan/bentylol rifaximin eluxadoline TCAs

What are all the options we have for IBS-C?

laxatives (bulk-forming, PEG, stim) linaclotide lubiprostone tenapanor plecanatide SSRIs

What are the options we have that can be used in both IBS-D and IBS-C?

pinaverium trimebutine peppermint oil probiotics

How does linaclotide work?

guanylate cyclase C agonist-->acts locally on GIT to stimulate fluid secretion, increase colonic transit, and reduce abdominal symptoms *very low oral bioavailability*

What is linaclotide used for?

treatment of moderate-severe IBS-C in adults improves constipation, bloating, abdominal pain *must be older than 6*

What is the most common adverse effect of linaclotide?

diarrhea generally well tolerated

Aside from IBS-C, what is another use of lubiprostone?

constipation caused by opioids

What is eluxadoline?

mu-opioid receptor agonist used for IBS-D to reduce abdominal pain and diarrhea

What is the role in therapy of probiotics for IBS?

can try one and add to existing meds dont know what to expect pick the ones that have IBS on the label

True or false: anti-cholinergics are first line agents in IBS

false less effect and more side effects than smooth muscle relaxants

What are the anti-cholinergics that are sometimes used for IBS?

Bentylol (dicyclomine) Buscopan (hyoscine)

True or false: the packaging of Buscopan has IBS as an indication

false

Will someone be put on Buscopan long-term?

no used for short-term relief of cramping

How does lubiprostone work?

chloride channel activator -increasing amount of fluid within intestines-->easier passage of stools

What is the use of tenapanor?

IBS-C -acts locally in GIT to inhibit NHE3=increase in BM and decrease in abdominal pain

What is currently the only Health Canada approved medication indicated for IBS-D?

eluxadoline (Viberzi)

What is plecanatide?

guanylate cyclase C agonist (same MOA as linaclotide) IBS-C

What is rifaximin?

short-term therapy for IBS-D (helps with diarrhea and abdominal pain) modulates gut microbiota by reducing GI bacterial load nausea is most common AE

What is the dosing of Bentylol/Buscopan?

1-2 10mg tablets per day up to a maximum of 6 tablets per day *stress/allergy listed on package, not IBS*