Irritable Bowel Syndrome

Question 1

What is IBS ?

A
B
C

Answer 1

IBS is a Functional bowel disorder in which abdominal discomfort or pain is associated with a change in bowel habit

Abdominal pain
Bloating
Change in bowel habit

Question 2

What are the 4 sub types of IBS

Answer 2

.IBD- diarrhoea predominant (most common)
.IBSC- constipation predominant
.IBFM- mixed
.IBSU- unclassified (other)

Question 3

What percent of the UK population suffer with IBS?

Answer 3

. Common condition 5-20 %

Question 4

Amongst which groups of people is IBS most common ?

Answer 4

. More likely to affect females
. Usually young adults 20-39
. Prevalence decreases as age increases

Question 5

What factors increase the likelihood of IBS (6)

Answer 5

. Dietary- food intolerances, caffeine, lactose, milk, spicy food

. Hormonal triggers

. Psychological function of GI tract can be impacted by stress/anxiety/depression

. Genetic

. GI inflammation (secondary IBD -inflammatory bowel disease)

. Certain medications such as antibiotics

Question 6

Diagnosis: what symptoms are associated with IBS (7)

Answer 6

. Abdominal pain
. Diarrhoea
. Constipation
. Alternating diarrhoea and constipation
. Feeling incomplete bowel clearance
. Abdominal distension (bloating)
. Flatulence (farting)

Question 7

What are some secondary GI symptoms (6)

Answer 7

. Nausea
. Belching
. Poor appetite
. Fullness after eating
. Heartburn
. Passage of mucus

Question 8

State the positive diagnostic criteria for IBS

Answer 8

1. Abdominal pain

• relieved by deflection
• associated with altered bowel frequency

2. At least two of the following

• altered stool passage (straining, urgency etc)
• abdominal bloating
• symptoms made worse by eating
• passage of mucus

Supporting symptoms: lethargy (nausea )

Question 9

How long does the patient need to have suffered IBS symptoms to be positively diagnosed

Answer 9

at least 6 months

Question 10

What questions should a patient with IBS symptoms be asked ? (4)

Answer 10

. Location of pain?
- lower left quadrant of abdomen usually but can present anywhere
-no radiation
-upper abdomen= peptic ulcer?

. Is bloating present?

. Flatulence/ belching

. Nature of stool?
- diarrhoea/ constipation
- urgency, when? Morning rush?
- mucus?

Question 11

What advice is given to patients with IBS symptoms?

Answer 11

. Diet- avoid dairy products, caffeine, fizzy drinks, spicy food, avoid sorbitol intake for diarrhoea
- balanced diet, adjust fibre intake depending on type of IBS

. Exercise

. Adequate fluid intake ~2L

. Increase intake of oats for bloating, decrease beans and chewing gum

Question 12

After diagnosis, when is the patient recorded to have another check up?

Answer 12

Within 2 months

Question 13

What are examples of antispasmodic drugs used to treat IBS ? (4)

Answer 13

Alverine

Mebeverine

Peppermint oil

Hyoscine (buscopan)

Question 14

How does alverine work ?

Answer 14

. Smooth muscle relaxant to relieve spasms, reduces pain and abdominal cramps

Question 15

What is the dose alverine and mebeverine and who can they not be given to?

Answer 15

. Tds (three times a day)
. Should not be used in pregnancy and children

Question 16

What warnings should a patient be given when starting peppermint oil?

Answer 16

. Do not chew- has enteric coated/ is gastro resistant To prevent stomach from digesting it too quickly. If chewed will irritate mouth+ oesophagus

. Can cause heart burn