Irritable bowel syndrome

Question 1

What is thought to be the general mechanism behind IBS?

Answer 1

A disturbance between the gut-brain interaction

Question 2

In Western populations, what % of patients report IBS-like symptoms?

Answer 2

20%

Question 3

What is meant by saying IBS is a ‘functional’ disorder?

Answer 3

there is no identifiable bowel disease underlying the symptoms

Question 4

Is IBS more common in men or women?

Answer 4

Women

Question 5

Give the three main symptoms of IBS using the IBS mnemonic:

Answer 5

1) intestinal discomfort
2) bowel habit abnormalities
3) stool abnormalities (water, loose, hard or associated with mucus)

Question 6

Give 6 factors that can trigger or worsen IBS symptoms:

Answer 6

1) anxiety and stress
2) depression
3) illness
4) caffeine
5) alcohol
6) certain foods

Question 7

Give 4 non-GI symptoms of IBS:

Answer 7

1) dysmenorrhoea
2) frequency and urgency with bladder emptying
3) joint pain
4) headaches

Question 8

Name 4 lab tests used to investigate IBS-like symptoms:

Answer 8

1) FBC for anaemia
2) Coeliac serology (anti-TTG antibodies)
3) Faecal calprotectin for IBD
4) inflammatory markers such as ESR and CRP

Question 9

Give the NICE criteria for IBS diagnosis:

Answer 9

the patient should have had at least 6 months of abdominal pain with at least one of:

1) pain and discomfort relieved by opening the bowels
2) bowel habit abnormalities (more or less frequent)
3) stool abnormalities (watery, loose, hard)

as well as at least two of:

1) straining, an urgent need to empty the bowels or incomplete emptying
2) bloating
3) worse after eating
4) passing mucus

Question 10

Give 6 pieces of lifestyle advice given to patients with IBS:

Answer 10

1) low FODMAP diet
2) drink enough fluids
3) regular, small meals
4) limit caffeine, alcohol and fatty foods
5) reduce stress
6) regular exercise

Question 11

What does FODMAP stand for?

Answer 11

1) fermentables
2) oligosaccharides
3) disaccharides
4) monosaccharides
5) and
6) polyols
these are food molecules that are poorly absorbed

Question 12

What drug can relieve diarrhoea in IBS?

Answer 12

loperamide

Question 13

What drug group can relieve constipation in IBS?

Answer 13

bulk forming laxatives

Question 14

What laxative should be avoided in IBS?

Answer 14

lactulose (causes bloating)

Question 15

What drug group can relieve cramping in IBS?

Answer 15

antispasmodics