Irritable Bowel Syndrome

Question 1

What is irritable bowel syndrome?

Answer 1

Mixed group of abdominal symptoms where no organic cause can be found

Question 2

What 3 types of IBS are there?

Answer 2

IBS-D: diarrhoea predominant

IBS-C: constipation predominant

IBS-M: mixed

Question 3

Causes of IBD?

Answer 3

Usually unknown

Genetic
Altered gut flora
Abnormal gut motility
Stress / psychological morbidity
Post GI infection

Question 4

What are the Rome III diagnostic criteria for IBS?

Answer 4

Recurrent abdominal pain or discomfort for at least 3 days a month in the past 3 months

PLUS

Two or more of the following:

1. Improvement with defaecation
2. Change in stool frequency
3. Change in stool form

Question 5

What are the clinical features of IBS?

Answer 5

Abdominal pain
Bloating
Change in bowel habit

Altered stool passage: straining, urgency, incomplete evacuation

Passage of mucus

Question 6

What are the red flag symptoms you should check for in a patient with suspected IBS?

Answer 6

Unexplained weight loss

Blood in stool

Family history of bowel/ovarian cancer

Change in bowel habit

Nocturnal symptoms

Question 7

Do people with IBS get nocturnal symptoms?

Answer 7

No, this is more a feature of IBD

Question 8

What would you expect to find in a clinical examination of an IBS patient?

Answer 8

Not a lot!

Bloating and tenderness

Question 9

What other conditions do you need to rule out before diagnosing with IBS?

Answer 9

Colorectal cancer
IBD
Coeliac
Lactose intolerance
Bile acid malabsorption
Infection

Question 10

IBS patients tend not to get symptom relief when they defecate. True or false?

Answer 10

False!

This is a feature that can distinguish IBS from something else

Question 11

Investigations of IBS?

Answer 11

Bloods

Faecal calprotectin: detects inflammation pointing to IBD

Colonscopy: look for physical damage, malignancy

Question 12

What blood tests should you do for a patient who may have IBS?

Answer 12

FBC look for anaemia due to rectal bleeding

LFT - check liver

CRP + ESR look for inflammation pointing to IBD or cancer

Serology look for antibodies to gluten etc.

Cultures to check for infection

Question 13

How would you manage mild IBS?

Answer 13

Education + reassurance: explain their condition is benign

Dietary modification: don’t eat things that aggravate the symptoms

Question 14

How would you manage moderate IBS?

Answer 14

Education + reassurance

Dietary modification

Medication

Psychological therapy if suspect it is stress/mood related

Question 15

How would you manage severe IBS?

Answer 15

Education + reassurance

Dietary modification

Medication

Psychological therapy

MDT approach

Refer to a pain centre

Question 16

What dietary modifications help in IBS?

Specifically in IBS-D?

Answer 16

Regular, small meals

Plenty of fluids

Reduce caffeine + fizzy drinks

In IBS-D cut down on insoluble fibre

Question 17

What type of foods are sources of:

• soluble fibre
• insoluble fibre?

Answer 17

Soluble:

• barley
• oats
• beans

Insoluble:

• cereals
• whole wheat bread
• lentils

Question 18

What is the FODMAP diet?

Answer 18

A diet that helps with IBS

Fermentable
Oligosaccharides
Disaccharides
Monosaccharides
And
Polyols

Question 19

What drugs are used to treat IBS?

Answer 19

Pain: anti-spasmodics buscopan (hyoscine hydrobromide)

Constipation: laxatives but not lactulose

Diarrhoea: anti-motility drugs

Tri-cyclic anti-depressants: last resort, are not for depression

Question 20

What laxatives are there?

One you have to be careful with, which one and why?

Answer 20

Bulk forming: fibogel

Osmotic: draws water in - lactulose

Stimulant: senna (can cause perforation in obstruction, abdo exam first)

Softner: docusate