Irritable Bowel Syndrome

Question 1

What is IBS?

Answer 1

Irritable bowel syndrome - Chronic relapsing problem of abdominal pain and bloating. Includes a change in bowel habits

Question 2

What are the Pathophysiological signs of IBD?

Answer 2

Disrupted GI motility
High-amplitude propagating contractions
exaggerated gastro-colic reflexes
pain

Question 3

What are the two types of visceral hypersensitivity?

Answer 3

peripheral sensitisation or central sensitisation

Question 4

What causes peripheral sensitisation?

Answer 4

Inflammatory mediators up-regulate the sensitivity of nociceptor terminals

Question 5

what causes central sensitisation?

Answer 5

increased sensitivity of spinal neurones

Question 6

what criteria is used to diagnose IBS?

Answer 6

Rome III Criteria

Question 7

IBS is defined as recurrent abdo pain for at least three days per month for 3 months + 2 or more of what?

Answer 7

Improvement with deification
onset associated with change in stool frequency
onset associated with a change in stool appearance

Question 8

What other symptoms suggest IBS? (6)

Answer 8

Bloating
Urgency to defecate 
Sensation of incomplete emptying
Mucus PR
Nocturia and poor sleep
Aggravated by stress

Question 9

What other illnesses is IBS associated with? (4)

Answer 9

Fibromyalgia
Chronic fatigue syndrome
TMJ dysfunction
Chronic pelvic pain

Question 10

What are the important points to learn in a history for people with IBS?

Answer 10

Bowel habits
Diet
Opiate use
Psychosocial factors

Question 11

What are the alarm features for IBS?

Answer 11

Short duration of symptoms
Woken up by altered bowel habits
Rectal bleeding
Weight loss
Anaemia
Family history of colorectal cancer
Recent antibiotic treatment

Question 12

What investigations would be performed?

Answer 12

FBC - check for ESR and CRP
Antibody testing for coeliac disease - TTG
Lower GI tests if older than 50

Question 13

What should be altered in a patients diet as a form of treatment?

Answer 13

Reduce fibre intake
Introduce regular meal times
Restrict coffee intake
Avoid sorbitol
Consider single food avoidance syndrome

Question 14

Why are opiates stopped?

Answer 14

prolonged use can cause opiate or narcotic bowel syndrome

Question 15

What is opiate bowel syndrome?

Answer 15

worsening pain control despite escalating dose
Reliance on opiates
Intensity of pain
No GI explanation for pain

Question 16

what does fibre do to a patient with IBS?

Answer 16

aggravates pain

Question 17

what do anti-diarrhoeals do?

Answer 17

inhibits peristalsis and gut secretion

Has no effect on pain

Question 18

what do anti-depressants do?

Answer 18

reduce diarrhoea
reduce afferent signals from gut
helps restore sleep pattern

Question 19

when is psychological treatment used?

Answer 19

If the patient is experiencing severe anxiety or depression and has had no response to anti-depressants

Question 20

what kind of psychological treatments are available?

Answer 20

relaxation therapy
cognitive behavioural therapy
Hypnosis