Irritable Bowel Syndrome

Question 1

Define IBS

Answer 1

Irritable Bowel Syndrome

• a form of functional, bowel disease, more than just a label for GI symptoms unexplained after investigations

Question 2

IBS Epidemiology

Answer 2

• 20% of North Americans
  
  • onset of symptoms usually in young adulthood
  • F > M

Question 3

IBS Pathophysiology

Answer 3

• normal perception of abnormal gut motility vs. abnormal perception of normal gut motility
  
  • abnormal motility
    
    • multiple abnormalities described, may be causative
  • psychological
    
    • stress may increase IBS symptoms but does not cause IBS

Question 4

IBS Diagnosis

Answer 4

Rome III Criteria

• ~12 wks in the past 12 months of abdominal discomfort or pain that has 2/3 features:
  
  • Relieved with defecation
  • Associated with a change in frequency of stool
  • Associated with a change in consistency of stool

‘Red-flags’ not present
Normal physical exam and investigations

Question 5

IBS Management

Answer 5

• stress management
  * typical diarrhoea management
  * typical constipation management
  * pain predominant
  * antispasmodic before meals
  * increase dietary fibre (bran)
  * tricyclic antidepressants (TCA)
  * selective serotonin reuptake inhibitors (SSRI)

Question 6

IBS Prognosis

Answer 6

• 80% improve over time
  
  • most have intermittent episodes
  • normal life expectancy

Question 7

IBS Antispasmodics used

Answer 7

• hyoscine butylbromide
  * mebeverine
  * peppermint oil

Question 8

Antidepressant Medications used for IBS

Answer 8

• tricyclic antidepressants (TCA)
  * Amitriptyline
  * Nortriptyline

     * selective serotonin reuptake inhibitors (SSRI)
        * Citalopram
        * Fluoxetine