Irritable Bowel Syndrome

Question 1

Define Irritable Bowel Syndrome (IBS)

Answer 1

A relapsing functional bowel disorder that has a significant negative impact on quality of life and social functioning

Question 2

What is IBS associated with?

Answer 2

Psychiatric distress

NOT serious disease or increased mortality

Question 3

When is onset most common?

Answer 3

Middle age

Question 4

What are the three subclasses of IBS? (and what is the prevalence of each)

Answer 4

• IBS-C is constipation dominant
• IBS-D is diarrhoea dominant
• IBS-M is mixed disease

Equal prevalence of each

Question 5

What is the Rome III diagnostic criteria for IBS?

Answer 5

More than 6 months history of intermittent or continuous abdo pain/ discomfort, bloating and change in bowel habit

Question 6

What is the Manning criteria for diagnosis of IBS?

Answer 6

Abdo pain relieved with defecation and altered stool frequency/ form alongside 2 of:

• Altered passage of stool e.g. straining, urgency, tenesmus
• Bloating
• Aggravation of Sxs by eating
• Passage of mucus PR

Question 7

What other Sxs can you get with IBS?

Answer 7

Fatigue, nausea, backache and dyspareunia

Question 8

What must be ruled out?

Answer 8

GI cancer/ IBD

Question 9

Is IBS a diagnosis of exclusion?

Answer 9

No - not any more
but if there is diagnostic uncertainty then there should be investigations to rule out significant pathology e.g. colon cancer/ IBD

Question 10

What investigations should be performed?

Answer 10

• FBC
• ESR and CRP
• Coeliac screen (EMA, TTG)
• Faecal calprotectin
• CA-125 if suspicion of ovarian cancer

Question 11

What investigations can be performed if indicated but are not routinely performed?

Answer 11

• TFTs
• Imaging with USS, sigmoidoscopy or barium enema
• FOBt
• Foecal OCP and MC&S
• Hydrogen breath test

Question 12

How is IBS managed

Answer 12

Conservative:

• Reassurance and explanation
• Reduction in stress
• Increased physical activity
• Drink fluids, reduce/ increase fibre as per diarrhoea/ constipation, reduce consumption of lactose
• Probiotics

Pharmacological

• Loperamide for diarrhoea
• Antispasmodics for pain
• Laxatives for constipation
• Antidepressants e.g low dose TCA, SSRI

Complimentary
- Acupuncture

Question 13

What antispasmodics can be used in IBS?

Answer 13

Mebeverine, hyoscine butylbromide, peppermint oil

Question 14

What laxatives should be avoided in IBS?

Answer 14

Lactulose