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Lower gastro-intestinal diseases > Irritable bowel syndrome > Flashcards

Irritable bowel syndrome Flashcards

1
Q

When does the onset of IBS usually occur?

A

Between 20-30 years old

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2
Q

Are males or females more likely to suffer?

A

Females are at least twice as likely to suffer

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3
Q

What is the incidence of IBS on the population?

A

10-20% of the population

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4
Q

What is the risk of IBS with a first degree relative?

A

Twice as likely

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5
Q

What is the aetiology of IBS?

A

No exact cause but food intolerances such as diary or gluten are known to be precursors.
Other factors include:
Post infective bowel dysfunction
Gut hypersensitivity
Altered colonic motility
Heightened pain sensation
Stress

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6
Q

What is the link between gastroenteritis and IBS?

A

1/6 patients who develop IBS have recently recovered from gastroenteritis

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7
Q

What type of disorder is IBS?

A

It is a functional disorder as there are no underlying gut pathology changes (as seen in IBD).

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8
Q

What tests are used in diagnosing IBS?

A

Blood tests/stool samples/colonoscopy may be used only to be able to rule out other conditions where pathology changes have occurred (IBD).

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9
Q

What are the main IBS symptoms?

A
  • Abdominal cramping
  • Diarrhoea/constipation/alternating
  • Flatulence
  • Bloating
  • Urgency to defecate
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10
Q

What are some additional IBS symptoms?

A
  • Acid indigestion
  • Nausea
  • Lethargy
  • Eating may worsen symptoms
  • Passing mucus in stools
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11
Q

How is a diagnosis of IBS made?

A

There must be abdominal pain present for at least 6 months which is:
Relieved by defecation, or: Increased/decreased bowel frequency or stool form

Plus at least 2 of the following:
Abdominal bloating/distension
Altered stool passage (straining, urgency, incomplete evacuation)
Worsened by eating
Passing mucus

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12
Q

How is a diagnosis made in secondary care?

A

Often the Rome IV classification is used in secondary care in order to make a diagnosis, which includes:
Abdominal pain 1 day per week in last 3 months
Symptoms began at least 6 months prior

Alongside >2 of the following:
Related to defecation
Change in stool frequency
Change in stool form

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13
Q

According to the Rome IV criteria, what are the four classifications of IBS?

A

IBS-C (constipation)
IBS-D (diarrhoea)
IBS-M (mixed)
IBS-U (unclassified)

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14
Q

What is the stool type criteria for a IBS-C diagnosis?

A

> 25% of stools are types 1/2
<25% are types 6/7

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15
Q

What is the stool type criteria for a IBS-D diagnosis?

A

> 25% of stools are types 6/7
<25% are types 1/2

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16
Q

What is the stool type criteria for a IBS-M diagnosis?

A

> 25% of stools are types 1/2 AND
25% of stools are types 6/7

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17
Q

What is the stool type criteria for a IBS-U diagnosis?

A

Person has IBS, but bowel habits can’t be categorised as above

18
Q

Main treatments for IBS?

A

Antispasmodic drugs
* Antidepressants
* Laxatives
* Loperamide
* Linaclotide

19
Q

Why are antispasmodics first line?

A

Because they are direct acting smooth muscle relaxants

20
Q

What are the three types of antispasmodics used?

A

Alverine Citrate
Mebeverine
Peppermint oil capsules

21
Q

What is the IBS dose for Alverine citrate?

A

60-120mg up to TDS

22
Q

What is the IBS dose for Mebeverine?

A

135mg TDS (20 mins before food) or 200mg BD for modified release preparations

23
Q

What is the IBS dose for Peppermint oil capsules?

A

1-2 capsules up to three times a day

24
Q

Which other antispasmodics aren’t recommended for use?

A

Hyoscine butylbromide and Dicycloverine can also be used but tend to have more antimuscarinic effects despite being very effective

25
Q

When are antispasmodics contra-indicated?

A

In intestinal obstruction or paralytic ileus due to affecting the motility of the drug

26
Q

When are anti-depressants recommended in IBS?

A

For patients that are experiencing pain alongside their IBS but its use in IBS is unlicensed.
Usually given for patients that have not responded to first line treatments.

27
Q

What is the first line anti-depressant for use in IBS?

A

Usually a tricyclic anti-depressant, at a notably lower dose than in mental health conditions.
Amitriptyline 10-30mg at night

28
Q

What is the second line anti-depressant?

A

SSRI (Citalopram, Fluoxetine, Sertraline) due to their pain modulating/peripheral effects on GI motility
Due to their off label use, their isn’t one that is recommended above another but is decided by the prescriber.

29
Q

Why is patient counselling important for anti-depressant drugs indicated for IBS?

A

May be alarmed when patients read the PIL due to predominate anti-depressant use

30
Q

Which laxatives are not recommended in IBS?

A

Lactulose due to increasing gas production and therefore potentially worsening symptoms.
Any other laxative is fine for IBS (specifically constipation type IBS).

31
Q

What is the dose for laxatives for IBS?

A

Dose should be titrated to symptoms

32
Q

What is the licensing requirement for the sale of OTC Loperamide for IBS?

A

Loperamide can be brought OTC for acute diarrhoea in patients over the age of 12. However if a patient is purchasing the medication for diarrhoea relating to IBS they must be over 18 to purchase and be diagnosed with IBS.

33
Q

What are the key points regarding the sale of Loperamide for IBS?

A

Only for attacks lasting up to 48 hours (refer if longer)

Can be used for 2 weeks maximum, as long as individual bouts are less
than 48 hours

34
Q

When is Linaclotide recommended?

A

For moderate to severe IBS-C in adults that have IBS diagnosed for 12 months or longer.
And only if the maximum dose of laxatives have not worked

35
Q

What dose of Linaclotide is recommended?

A

290mcg once daily 30 minutes before food

36
Q

When should Linaclotide be avoided?

A

IBD or GI obstruction

37
Q

How do anti-spasmodics work (Mebeverine)?

A
  • It specifically acts on smooth muscle cells
  • Blocks voltage operated sodium channels
  • This prevents build up of intracellular calcium, leading to reduction in contractility
  • This reduces symptoms of colonic hypermotility
38
Q

What type of drug is Linaclotide?

A

Guanylate cyclase-c (GC-C) agonist

39
Q

How does Linaclotide work?

A

GC-C activation leads to increased production of cyclic guanosine
monophosphate (cGMP) * Increased cGMP stimulates the cystic fibrosis transmembrane conductance regulator (CFTR) ion channel
* CFTR ion channel increases secretion of chloride and bicarbonate into the intestinal lumen (this increase moisture content)
* GI transit increased

40
Q

What are the red flag IBS symptoms that would warrant referral?

A
  • Unintentional weight loss
  • Unexplained rectal bleeding
  • Family history of bowel/ovarian cancer
  • Loose stools for >6 weeks in patients >60 years old
  • Anaemia
  • Elevated inflammatory markers (?IBD)
  • Abdominal/rectal masses

Lower gastro-intestinal diseases (15 decks)

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