Irritable Bowel Syndrome Flashcards
Define irritable bowel syndrome
Chronic condition characterised by abdominal pain and bowel dysfunction with no
underlying structural abnormalities – diagnosis of exclusion (Rome criteria)
What are the causes/risk factors of irritable bowel syndrome?
No specific aetiological cause (mucosa is normal)
Disorder of GI motility with a potential inflammatory/immune basis often triggered by stress
• Female
• Age <50 years
• GI infection
• Previous physical or sexual abuse
What are the signs and symptoms of irritable bowel syndrome?
Symptoms: • Abdominal discomfort/cramps • Altered bowel habit • Pain often relieved by defecation • Bloating/abdominal distension
Signs:
none
What investigations are carried out for irritable bowel syndrome?
- FBC - normal
- U&Es - normal
- LFTs - normal
- ESR - normal
- CRP - normal
- Stool Studies (microscopic culture for infectious pathogens) - normal
- Coeliac Serology - normal
- Abdominal USS - normal, excludes gallstones.
- H. Pylori Tests - negative
- AXR - normal
- Colonoscopy - normal
What is the management for irritable bowel syndrome?
Constipation-Predominant: • Adequate water intake • Adequate fibre intake • Physical activity • Reduce intake of insoluble fibres (flatulence) • Laxatives • Lubiprostone or Linaclotide
Diarrhoea-Predominant: • Avoid sorbitol, alcohol and caffeine. • Reduce fibre intake • Avoid trigger foods • Bulking agents • Loperamide (opioid) • Alosetron (5-HT3 antagonist)
Colic and Bloating: • Anti-spasmodics: - Mebeverine - Hyoscine • Low FODMAP Diets: Fermentable oligosaccharides, disaccharides, monosaccharides, alcohol and polyols. • Probiotics
Psychological:
• Cognitive behavioural therapy
• TCA –amitriptyline; low dose for visceral hypersensitivity, not as an anti-depressant.
What are the complications of irritable bowel syndrome?
- diverticulosis
* physical and psychological morbidity : reduced QoL
