Irritable Bowel syndrome Flashcards
What is the background of IBS?
Chronic, relapsing problem
Abdo pain
Bloating
Change in bowel habit
Usually peaks in 30-40’s
Females get it more than males
What is the basic pathophsyioogy of IBS?
Genes + Environment
visceral hypersensitivity
What is visceral hypersensitivity?
Seen in 2/3 of patients
Peripheral sensitisation - inflammatory mediators up-regulate sensitivity of nociceptor terminals
Central sensitisation - increased sensitivity of spinal neurones
What might be some evidence of peripheral or central hypersensitivity?
Peripheral - up to 20% recall onset after infectious gastroenteritis
Central - increased pain radiation to somatic structures e.g. fibromyalgia
What is the rome 3 criteria for IBS?
Recurrent abdo pain/discomfort for at least 3 days per month for 3 months
And 2 or more of:
Improvement with defecation
Onset assoc with a change in stool frequency
Onset associated with a change in stool form (appearance)
What might be some other clues/symtoms for IBS?
Bloating Urgency Sensation of incomplete emptying Mucus per rectum Nocturia (and poor sleep) Aggravated by stress
What other illness might IBS be associated with?
Fibromyalgia
Chronic fatigue syndrome
Temporomandibular joint dysfunction
Chronic pelvic pain
What are some physiological features of IBS?
At least 50% are depressed, anxious or hypochondriacal
Describe what you might ask about in a history of someone with IBS?
Bowel habit
Bloating, nocturia
Diet (bread, fibre, meal times, bizarre exclusions)
Trigger factors (infection, menstruation, drugs)
Opiate use (codeine and opiate/Narcotic bowel syndrome)
Psychosocial factors (stress)
Underlying fears (cancer)
Name some alarm syndromes of IBS?
Age > 50 Short duration of symptoms Woken up from sleep by altered bowel habit Rectal bleeding Weight loss Anaemia FH of colorectal cancer Recent antibiotics
What investigations should you carry out on someone with suspected IBS?
RBC
ESR/plasma viscosity
CRP
Antibody testing for coeliac disease (TTG)
Lower GI tests if aged >50 or strong FH of CRC
How do you treat IBS? Diet?
Regular meal times
Reduce fibre
How do you treat IBS? Drugs?
Stop opiate analgesia
anti-diarrhoeals
Anti-spasmodics
Anti-depressants
What is opitate/narcotic bowel syndrome?
Prolonged use of opiates
Worsening pain control despite escalating dose
Reliance on opiates
Progression of frequency, duration and intensity of pain
No GI explanation for pain
What does lactulose promote?
Flatulence
