Irritable bowel syndrome

Question 1

What is IBS?

Answer 1

• Abdominal symptoms where no organic cause can be found
• Probably due to:
  
  • Disorder of interstinal motility
  • Enhanced visceral perception

Question 2

Describe the diagnosis of IBS?

Answer 2

• ROME III Criteria without ALARM symptoms
• FBC, faecal calprotectin and sigmoidoscopy often done in tandem and are normal

Question 3

Describe the ROME III criteria?

Answer 3

• Recurrent abdominal pain for at least 3 days per month in last 3 months
• Associated with 2 or more of the following:
  
  • Improvement with defecation
  • Onset associated with change in frequency of stool
  • Onset associated with a change in appearance of stool

Question 4

What are the alarm symptoms in IBS?

Answer 4

• Age >50; male gender
• Anaemia
• Weight loss
• Rectal bleeding
• Nocturnal symptoms
• Family history of colon cancer

Question 5

Clinical signs of IBS?

Answer 5

• Examination may be normal
• May be generalised abdo tenderness

Question 6

Name some common causes of GI malabsorption in the UK?

Answer 6

• Coeliac
• Crohns
• Chronic pancreatitis

Question 7

Describe the management of IBS?

Answer 7

• Focus on controlling symptoms
• Lifestyle changes -> cognitive therapy -> pharmacotherapy
  
  • Diarrhoea
  • Constipation
  • Colic/bloating
  • Psychological symptoms

Question 8

Describe the management of constipation in IBS?

Answer 8

• Ensure adequate water and fibre
• Promote physical activity
• Simple laxatives
  
  • Lactulose ferments and can worsen bloating

Question 9

Describe the management of diarrhoea in IBS?

Answer 9

• Avoid certain sweetenders, alcohol, caffeine
• Reduce fibre in diet
• Envourage patients to identify trigger foods

Question 10

Describe the management of colic/bloating in IBS?

Answer 10

• Oral antispasmodics
  
  • Mebeverine
  • Hyoscine butylbromide
• Probiotics may help flatulence/bloating

Question 11

Treatment pathway for IBS

Answer 11