Irritable Bowel Syndrome Flashcards
Define irritable bowel syndrome as per Rome III criteria
Recurrent abdo pain for 3 days/month for 3 months+ at least 2 of
Improvement with defecation
Change in stool frequency
Change in stool appearance
Is IBS an acute or chronic presentation?
Chronic - has been going on for months
Who is more commonly affected by IBS - males or females?
Females 2:1 Males
Oestrogen-driven disease
The aetiology of IBS is unclear, but what is the most common proposed mechanism seen in 2/3 of patients?
Visceral hypersensitivity - peripheral sensitization of visceral afferents in the ENS + ANS
List some symptoms of IBS
Bloating Abdo pain/discomfort Urgency Nocturia Mucus stool Incomplete emptying
What are the most common trigger factors of IBS?
Diet (bread, low-fibre) Infection Menstruation Drugs (opiates e.g. codeine) Psychological factors
What are some alarm features of IBS symptoms that warrant deeper investigation?
Age > 50 More recent onset Woken up from sleep needing toilet Rectal bleeding Weight loss Anaemia Family history of CRC
List some general investigations done for IBS
FBC
CRP
Antibody test for coeliac disease
Lower GI test if age > 50
What is the initial, and often most effective, management of IBS?
Improve diet - reduce fibre and meal times
Stop opiates and analgesia
Name an anti-spasmodic drug that could be used for IBS
Mebeverine
Hyoscine
Name an anti-diarrhoeal agent
Loperamide
Name an anti-depressant agent that may be used for IBS
Amitryptiline
List the three types of IBS
IBS-D (diarrhoea)
IBS -C (constipation)
IBS-M (mixed)
What are the main classes of drugs used in the treatment of IBS
Anti-diarrhoeals
Anti-spasmodics
Anti-depressants
Give some classes of drugs used to treat constipation
Laxatives --- Stimulant (Senna) --- PEG based (lactulose, isphaghula, laxido) Anti-spasmodics Anti-depressants
