Irritable bowel syndrome Flashcards
What are the clinical guidelines for IBS diagnosis and management?
NICE published clinical guidelines on the diagnosis and management of irritable bowel syndrome (IBS) in 2008.
What symptoms should be present for at least 6 months to consider a diagnosis of IBS?
Abdominal pain, and/or bloating, and/or change in bowel habit.
What criteria confirm a positive diagnosis of IBS?
Abdominal pain relieved by defecation or associated with altered bowel frequency/stool form, plus 2 of the following 4 symptoms: altered stool passage, abdominal bloating, symptoms made worse by eating, passage of mucus.
What additional features may support the diagnosis of IBS?
Lethargy, nausea, backache, and bladder symptoms.
What are the red flag features to enquire about in IBS?
Rectal bleeding, unexplained/unintentional weight loss, family history of bowel or ovarian cancer, onset after 60 years of age.
What are the suggested primary care investigations for IBS?
Full blood count, ESR/CRP, coeliac disease screen (tissue transglutaminase antibodies).
What is the management of irritable bowel syndrome (IBS)?
The management of IBS varies considerably between patients and can be difficult. NICE updated its guidelines in 2015.
What is the first-line pharmacological treatment for pain in IBS?
Antispasmodic agents.
What is the first-line pharmacological treatment for constipation in IBS?
Laxatives, but avoid lactulose.
What is the first-line pharmacological treatment for diarrhoea in IBS?
Loperamide.
When may linaclotide be considered for constipation in IBS?
If optimal or maximum tolerated doses of previous laxatives from different classes have not helped and they have had constipation for at least 12 months.
What is the second-line pharmacological treatment for IBS?
Low-dose tricyclic antidepressants (e.g., amitriptyline 5-10 mg) are preferred over selective serotonin reuptake inhibitors.
What psychological interventions may be considered for refractory IBS?
Cognitive behavioural therapy, hypnotherapy, or psychological therapy.
What complementary and alternative medicines are recommended for IBS?
Do not encourage the use of acupuncture or reflexology for the treatment of IBS.
What general dietary advice is given for IBS?
Have regular meals, avoid missing meals, drink at least 8 cups of fluid per day, restrict tea and coffee to 3 cups per day, reduce intake of alcohol and fizzy drinks.
What should be limited in the diet for IBS?
Limit fresh fruit to 3 portions per day and reduce intake of high-fibre food.
What should be avoided for diarrhoea in IBS?
Avoid sorbitol.
What can be increased in the diet for wind and bloating in IBS?
Consider increasing intake of oats and linseeds (up to one tablespoon per day).
