Irritable Bowel Syndrome

Question 1

What is irritable bowel syndrome?

Answer 1

A chronic functional disorder with no organic cause Characterized by abdominal pain and altered bowel habits

Question 2

What criteria aids in the diagnosis of irritable bowel syndrome?

Answer 2

ROME IV criteria

Question 3

According to the Rome criteria, IBS diagnosis should contain what?

Answer 3

Recurrent abdominal pain, at least one day per week in the last three months and two or more of the following: pain relates to defecation, change in frequency of BM, change in form of stool

Question 4

2/3 of IBS patients are what gender?

Answer 4

Female

Question 5

What percent of the population has IBS signs and symptoms?

Answer 5

10% of 15%, most commonly diagnosed G.I. condition

Question 6

At what age does IBS usually present?

Answer 6

Usually late teens/early 20s

Question 7

Is the exact cause of IBS known?

Answer 7

No

Question 8

Possible etiologies of IBS?

Answer 8

Abnormal motility (primary motility disorder, or secondary reaction to stress), visceral hypersensitivity (distention and bloating), intestinal infection, enteric infection, food sensitivity, psychosocial

Question 9

When can enteric infection cause IBS signs and symptoms?

Answer 9

Within one year after episode of bacterial gastroenteritis, after viral or parasitic infections, women/those with increased stress at time of gastroenteritis at risk for post infectious IBS

Question 10

Greater than 50% of those presenting with IBS have what underlying conditions?

Answer 10

Depression, anxiety, or somatization

Question 11

Clinical features of IBS?

Answer 11

Intermittent abdominal pain (crampy, lower abdomen), symptoms related to the type of IBS, patient may complain of multitude of other symptoms

Question 12

What kind of symptoms are related to IBS with diarrhea?

Answer 12

Frequent loose stools, small to moderate volume, waking hours (if someone has nocturnal diarrhea it is a red flag and they need to be worked up for cancer)

Question 13

What symptoms are related to IBS with constipation?

Answer 13

Constipation can last days to months

Question 14

What other symptoms may a patient with IBS complain of?

Answer 14

Heartburn, fatigue, headache, uro and gyn sx, anxiety, depression

Question 15

What are some alarm symptoms that may not be IBS, and could be something more serious?

Answer 15

Acute onset after 50 years old, nocturnal diarrhea, hematochezia, weight loss and fever, lab abnormalities, family history of colon cancer/IBD/celiac disease
Need to be worked up further

Question 16

Is the physical exam for IBS usually normal?

Answer 16

Yes

Question 17

What is the diagnostic work up for IBS?

Answer 17

Rome criteria, avoid unnecessary tests, CBC, stool, for O&P if patient has traveled, colonoscopy in some cases, possibly evaluate for celiac

Question 18

Which patient complaining of IBS should be given a colonoscopy?

Answer 18

Patients over 45 years old, family history of colon cancer, alarm symptoms

Question 19

When should patients complaining of IBS be evaluated for celiac disease?

Answer 19

If diarrhea predominant IBS

Question 20

Treatment for IBS?

Answer 20

Educate and support patient, reinforce chronic nature of IBS, move away from trying to find a cause, make a plan for patient to cope with symptoms such as diet, pharmacotherapy, psychological therapies

Question 21

Diet suggestions for someone with IBS?

Answer 21

Avoid fatty food, alcohol, caffeine (poorly tolerated)
Exclude lactose and gluten intolerance
Avoid large meals
Gas and bloating can be worsened by carbs, certain fruits, and veggies
* FODMAPS diet

Question 22

Who is pharmacotherapy for IBS reserved for?

Answer 22

Patients with severe symptoms

Question 23

Is there standard drug treatment or medications that aim to treat symptoms of IBS?

Answer 23

No

Question 24

What medication can be used for severe IBS?

Answer 24

Anti-spasmodic’s-anticholinergics: dicyclomine
Anti-diarrheal agents : Imodium
Anti-constipation agents-osmotic laxatives: MiraLAX, linaclotide (Linzess)
Psychotropic agents -tricyclic antidepressants (diarrhea dependent IBS)

Question 25

What should you check before administering pharmacotherapy for IBS?

Answer 25

Check to see how carefully patient has been following diet restrictions

Question 26

What psychological therapy can be helpful for IBS?

Answer 26

Relaxation techniques, hypnotherapy, cognitive behavioral therapy, psych eval