Irritable bowel syndrome

Question 1

When should the diagnosis of IBS be considered?

Answer 1

At least 6/12 of abdominal pain +/- bloating +/- change in bowel habit

Question 2

Diagnostic criteria for IBS?

Answer 2

Either:

abdominal pain relieved by defaecation

abdominal pain associated with altered bowel frequency or stool form

And 2/4 of:

altered stool passage
bloating/distension/hardness
symptoms made worse by eating
passage of mucus

Question 3

What can exacerbate IBS symptoms? (3)

Answer 3

Stress
Menstruation
Gastroenteritis

Question 4

What may IBS be confused for in female patients?

Answer 4

Endometriosis

Question 5

Features which suggest a diagnosis other than IBS?

Answer 5

Elevated inflammatory markers
Weight loss
Mouth ulcers
Positive coeliac serology

Question 6

Which diet is associated with an improvement in symptoms?

Answer 6

Low FODMAP diet

Question 7

Non-pharmacological treatments? (2)

Answer 7

Peppermint oil

Probiotic yoghurts

Question 8

Symptomatic relief of:

a) constipation
b) diarrhoea
c) colic/bloating

Answer 8

a) ispaghula, methylcellulose
b) loperamide
c) mebeverine

Question 9

Which laxative should be avoided and why?

Answer 9

Lactulose- causes fermentation which worsens bloating

Question 10

Minimum investigations in suspected IBS?

Answer 10

FBC
ESR
CRP
TTG

Question 11

What test can help distinguish between IBS and IBD?

Answer 11

Faecal calprotectin- released in the bowel in presence of inflammation, indicates possible IBD