Irritable Bowel Syndrome Flashcards
What is irritable bowel syndrome?
A chronic functional disorder with no organic cause Characterized by abdominal pain and altered bowel habits
What criteria aids in the diagnosis of irritable bowel syndrome?
ROME IV criteria
According to the Rome criteria, IBS diagnosis should contain what?
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
2/3 of IBS patients are what gender?
Female
What percent of the population has IBS signs and symptoms?
10% of 15%, most commonly diagnosed G.I. condition
At what age does IBS usually present?
Usually late teens/early 20s
Is the exact cause of IBS known?
No
Possible etiologies of IBS?
Abnormal motility (primary motility disorder, or secondary reaction to stress), visceral hypersensitivity (distention and bloating), intestinal infection, enteric infection, food sensitivity, psychosocial
When can enteric infection cause IBS signs and symptoms?
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
Greater than 50% of those presenting with IBS have what underlying conditions?
Depression, anxiety, or somatization
Clinical features of IBS?
Intermittent abdominal pain (crampy, lower abdomen), symptoms related to the type of IBS, patient may complain of multitude of other symptoms
What kind of symptoms are related to IBS with diarrhea?
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)
What symptoms are related to IBS with constipation?
Constipation can last days to months
What other symptoms may a patient with IBS complain of?
Heartburn, fatigue, headache, uro and gyn sx, anxiety, depression
What are some alarm symptoms that may not be IBS, and could be something more serious?
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
Is the physical exam for IBS usually normal?
Yes
What is the diagnostic work up for IBS?
Rome criteria, avoid unnecessary tests, CBC, stool, for O&P if patient has traveled, colonoscopy in some cases, possibly evaluate for celiac
Which patient complaining of IBS should be given a colonoscopy?
Patients over 45 years old, family history of colon cancer, alarm symptoms
When should patients complaining of IBS be evaluated for celiac disease?
If diarrhea predominant IBS
Treatment for IBS?
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
Diet suggestions for someone with IBS?
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
Who is pharmacotherapy for IBS reserved for?
Patients with severe symptoms
Is there standard drug treatment or medications that aim to treat symptoms of IBS?
No
What medication can be used for severe IBS?
Anti-spasmodic’s-anticholinergics: dicyclomine
Anti-diarrheal agents : Imodium
Anti-constipation agents-osmotic laxatives: MiraLAX, linaclotide (Linzess)
Psychotropic agents -tricyclic antidepressants (diarrhea dependent IBS)
What should you check before administering pharmacotherapy for IBS?
Check to see how carefully patient has been following diet restrictions
What psychological therapy can be helpful for IBS?
Relaxation techniques, hypnotherapy, cognitive behavioral therapy, psych eval
