Irritable Bowel Syndrome

Question 1

What is IBS?

Answer 1

Functional GI disorder characterised by recurrent abdominal pain and alterations in bowe habits with no organic cause. It should be considered if a patient presents with any of following for 6 months: Abdominal pain, Bloating or Change in bowel habit

Question 2

Explain the diagnostic criteria for IBS

Answer 2

Patient must have abdominal pain relieved by defication or associated with altered bowel frequency and 2 of following:
1. Altered stool passage (urgency, straining)
2. Abdominal bloating, distention or tenderness,
3. Symptoms made worse by eating,
4. Passage of mucus
Can also have lethargy, nausea, backache

Question 3

What are the red flag symptoms for IBS?

Answer 3

Rectal bleeding, unexplained weight loss, family history of ovarian cancer and onset after age 60.

Question 4

What are the primary care investigations for IBS

Answer 4

FBC,
ESR/CRP,
Coeliac’s screen

Question 5

What is the management of IBS?

Answer 5

First line according to predominant symptoms:
Pain - antispasmodics,
Constipation - laxitives but avoid lactulose.
Diarrhoea - loperamide

Question 6

What is the second line treatment for IBS?

Answer 6

low dose antidepressants eg, amitriptyline

Question 7

What is an antidiarrhoeal agent?

Answer 7

Opioid agonist - loperamide