Irritable bowel syndrome Flashcards
How common is it?
Population-based studies estimate the prevalence of irritable bowel syndrome at 10-20% and the incidence of irritable bowel syndrome at 1-2% per year.
Who does it affect?
F>M
25% fewer diagnoses after 50
No association with socioeconomic status
What causes it?
Usually no specific or unique pathology.
Microscopic inflammation has been documented in some cases.
What are the risk factors?
Female sex Current smoking Frequent alcohol consumption Younger age Stress Absence of hypertension
What are the symptoms?
Altered bowel habit
- Constipation
- Diarrhoea
- Postprandial urgency
- Alteration between constipation and diarrhoea
Abdominal pain:
- Diffuse pain w/o radiation
- Common sites = lower abdo, esp left lower quadrant
- Acute episodes of sharp pain superimposed on more constant dull ache
Also:
- Abdominal bloating/distention
- Clear or white mucorrhea
- Dyspepsia
- Nausea, vomiting
- Sexual dysfunction
- Urinary frequency/urgency
Can be constipation predominant, diarrhoea predominant or mixed.
What signs might the patient have on examination?
Overall healthy appearance but often tense and anxious.
What are the differential diagnoses?
Abdominal Angina Acute Intermittent Porphyria Anxiety Disorders Bacterial gastroenteritis Bacterial Overgrowth Syndrome Biliary Colic Biliary Disease Celiac Disease Chronic Mesenteric Ischemia Chronic Pancreatitis Colon Cancer Endometriosis Food Allergies Giardiasis Hypercalcemia Hyperthyroidism and Thyrotoxicosis Hypothyroidism Inflammatory Bowel Disease Lactose Intolerance Malignant Neoplasms of the Small Intestine Mesenteric Artery Thrombosis Mesenteric Venous Thrombosis Pancreatic Cancer Pheochromocytoma Postcholecystectomy Syndrome Somatostatinomas Ulcerative Colitis Viral Gastroenteritis
How would you investigate this patient?
Bloods: FBC, CRP, immunology, U&E, LFTs AXR OGD H. pylori microbiology Abdo USS Celiac screen
How would you explain this condition to the patient?
IBS is a common condition that affects the digestive system.
It causes symptoms like stomach cramps, bloating, diarrhoea and constipation. These tend to come and go over time, and can last for days, weeks or months at a time.
It’s usually a lifelong problem. It can be very frustrating to live with and can have a big impact on your everyday life.
There’s no cure, but diet changes and medicines can often help control the symptoms.
The exact cause is unknown – it’s been linked to things like food passing through your gut too quickly or too slowly, oversensitive nerves in your gut, stress, and a family history of IBS.
How do you think the patient and/or family might be affected by the diagnosis? Will it affect their
ability to work/care for themselves?
Perhaps relieved that it isn’t something more serious
If well-controlled it shouldn’t have too much of an impact, however some people can find it very debilitating and distressing.
If may affect their ability to work if severe.
What questions are they likely to have?
Is it curable?
What can I do to make it better (diet/lifestyle etc)?
Is there any medication I can take?
Will I have this for the rest of my life?
What treatment/s (surgical, pharmacological and non-pharmacological) would you discuss with
them? What risks and benefits of treatment are there?
Diarrhoea predominant
- Avoid legumes & excessive fibre
- Trial low FODMAP diet
- Antidiarrhoeal drugs (loperamide, codeine, colestyramine)
- Amitriptyline or imipramine
- Rifaximin
Constipation predominant
- High roughage diet
- Fybogel etc
- Macrogol or lactulose
- Prucalopride or linaclotide
Pain and bloating
- Low FODMAP, exclude wheat, exclude diary, exclude gluten
- Spasmolytic drugs (mebeverine, peppermint oil, hyoscine)
- Probiotics
- Rifaximin
- Amitriptyline or imipramine
Persistent symptoms
- Duloxetine
- Relaxation
- Biofeedback
- Hypnotherapy
