Irritable Bowel Syndrome Flashcards
Define irritable bowel syndrome
Chronic, relapsing, and often debilitating disorder of gut-brain interaction characterised by abdominal pain/discomfort
What are the types of functional abdominal pain
Irritable bowel syndrome
Abdominal migraine
Functional dyspepsia
Functional abdominal pain (not otherwise specified)
Risk factors for irritable bowel syndrome
Enteric infection, GI inflammation
Family history
Diet: alcohol, caffeine, spicy, fatty
Drugs e.g. antibiotics
Psychological comorbidity (such as stress, anxiety and/or depression)
Symptoms of irritable bowel syndrome
Abdominal pain or discomfort
- At least 6 months
- Exacerbated by eating
- Relieved by defecation
Change in stool form/frequency
- frequency (increased or decreased), or stool form (hard, lumpy, loose, or watery)
- Straining, urgency, incomplete evacuation
- Mucous
Bloating, tension, hardness
Extra-intestinal manifestations: lethargy, nausea, back pain, headache, gynaecological, bladder symptoms
Differentials for irritable bowel syndrome
Inflammatory bowel disease
Malignancy
Hypothyroidism
Coeliac
GI infection
diverticular disease
Chronic pancreatitis
Gallstones
Peptic ulcer
Investigations for irritable bowel syndrome
Faecal calprotectin
FBC
ESR/CRP
Coeliac serology
Management for irritable bowel syndrome
Conservative:
- Explain the condition
- Diet: regular meals
- Drink adequate fluid
- Regular physical activity
- Weight management
- Identify any associated stress, anxiety and/or depression
- Psychotherapy: Cognitive-behavioral therapy, hypnotherapy, and mindfulness-based therapy
Medical management
What is the symptom-targeted management for irritable bowel syndrome
Diarrhoea
1. Reduce insoluble fibre e.g. wholemeal high-fibre flour and breads. Reduce caffeine, alcohol, carbonates symptoms, gas-producing
2. Loperamide
Constipation
1. soluble fibre supplements/foods high in soluble fibre
2. Bulk-forming laxative
3. Linaclotide
Abdo pain
1. Mebeverine
2. TCA OR SSRIs
