Irritable Bowel Syndrome

Question 1

What is IBS?

Answer 1

A chronic condition (>6 months) of abdominal pain/discomfort, bloating, or altered bowel habits

IBS is characterized as a functional condition with no identifiable bowel disease underlying the symptoms.

Question 2

What does ‘functional’ mean in the context of IBS?

Answer 2

No identifiable bowel disease underlying the symptoms.

Question 3

What does the IBS mnemonic ‘IBS’ stand for?

Answer 3

• I - intestinal discomfort (abdominal pain relating to bowels)
• B - bowel habit abnormalities
• S - stool abnormalities (watery, loose, hard, mucus)

Question 4

List some suggestive features of IBS.

Answer 4

• Worsened by eating
• Improved with defecations
• Dietary factors (e.g. worse with caffeine)
• Passing mucus

Question 5

What are common symptom triggers for IBS?

Answer 5

• Anxiety
• Stress
• Depression
• Sleep disturbance
• Illness
• Medications
• Certain foods, alcohol, caffeine

Question 6

True or False: IBS can present with rectal bleeding.

Answer 6

False

Question 7

What are red flag symptoms that IBS should not present with?

Answer 7

• Rectal bleeding
• Weight loss (unintentional)
• Rectal or abdominal mass
• Iron deficiency anaemia

Question 8

List some differential diagnoses for IBS.

Answer 8

• Bowel cancer
• IBD
• Coeliac disease
• Ovarian cancer
• Pancreatic cancer

Question 9

What investigations are commonly performed for IBS?

Answer 9

• Anaemia (FBC)
• Inflammatory markers (ESR, CRP)
• Coeliac screen (anti-TTG)
• IBD (faecal calprotectin)
• Ovarian cancer (Ca125)
• Colorectal cancer (QFIT)

Question 10

What lifestyle advice is recommended for managing IBS?

Answer 10

• Drinking plenty fluids
• Regular small meals
• Adjusting fibre intake
• Limiting trigger foods/drinks
• Low FODMAP diet
• Stress reduction
• Regular exercise
• Probiotics and prebiotics

Question 11

What are the laxative options for IBS with constipation?

Answer 11

• Bulk-forming (e.g. ispaghula husk)
• Osmotic (e.g. macrogols)
• Stimulant (e.g. senna)

Question 12

What is the antimotility drug used for IBS with diarrhoea?

Answer 12

Loperamide (stop after 3 months if no benefit)

Question 13

What are the antispasmodics used for abdominal pain/cramps in IBS?

Answer 13

• Mebeverine
• Hyoscine butylbromide (buscopan)
• Peppermint oil

Question 14

What treatments are available for treatment-resistant IBS?

Answer 14

• Amitriptyline
• SSRIs
• CBT
• Specialist referral