Irritable Bowel Syndrome Flashcards
Three Sub-Types of IBS
Diarrhoea predominant
Constipation predominant
Mixture between the two
Pathophysiology
genes + ENVIRONMENT
disturbed GI motility
Visceral hypersensitivity
Viceral Hypersensitivity
Seen in 2/3 of patients
Mechanisms =
Peripheral sensitisation
Central sensitisation
Rome III Criteria for IBS
Recurrent abdo pain/discomfort for at least 3 days per month for 3 months + 2 or more of:
Improvement with defecation
Change in stool frequency
Change in stool form (appearance)
Additional Symptoms
Bloating Urgency Sensation of incomplete emptying Mucus per rectum Nocturia (and poor sleep) Aggravated by stress
Associated Illnesses
Fibromyalgia
Chronic fatigue syndrome
Temporomandibular joint dysfunction
Chronic pelvic pain
Psychological Features
Depression
Anxiety
Hypochondriacal
History
Bowel habit
Bloating, nocturia
Diet (bread, fibre, bizarre exclusions)
Trigger factors (infection, menstruation, drugs)
Opiate use
Psychosocial factors (stress)
Underlying fears ("cancer")Red Flags
Age >50 Short duration of symptoms Woken from sleep by altered bowel habit Rectal bleeding Weight loss Anaemia FH of colorectal cancer Recent antibiotics
Investigations
FBC ESR/plasma viscosity CRP Antibody testing for coeliac disease Red flags = Lower GI investigations
Treatment - Diet
Regular meal times Reduce fibre intake Restrict tea and coffee intake Reduce intake of "resistant starch" If diarrhoea, avoid sorbitol Persistent symptoms = consider single food avoidance and exclusion diets (e.g. low FODMAP diet)
Treatment - Drugs
Stop opiate analgesia
Anti-diarrhoeals
Anti-spasmodics
Anti-depressants
Laxatives
Lactulose promotes flatulence
PEG based are better as effect doesn’t wear off
Anti-Diarrhoeals
Loperamide
Inhibits peristalsis, gut secretions
Benefits diarrhoea
Use PRN/prophylactically
Anti-Depressants
Tricyclics Reduce diarrhoea Reduce pain Help restore sleeping pattern Side effects = Dry mouth Fatigue Solomance
