Irritable Bowel Syndrome Flashcards
What is IBS?
Irritable bowel syndrome is a “functional bowel disorder”. This means that there is no identifiable organic disease underlying the symptoms. The symptoms are a result of the abnormal functioning of an otherwise normal bowel.
Symptoms
Diarrhoea •Constipation •Fluctuating bowel habit •Abdominal pain •Bloating •Worse after eating •Improved by opening bowels
Criteria for diagnosis
Excluding other pathology
Normal FBC, ESR and CRP blood tests
•Faecal calprotectin negative to exclude inflammatory bowel disease
•Negative coeliac disease serology (anti-TTG antibodies)
•Cancer is not suspected or excluded if suspected
Criteria for diagnosis (symptoms)
Abdominal pain / discomfort:
•Relieved on opening bowels, or
•Associated with a change in bowel habit
AND 2 of: •Abnormal stool passage •Bloating •Worse symptoms after eating •PR mucus
Lifestyle
Adequate fluid intake
•Regular small meals
•Reduced processed foods
•Limit caffeine and alcohol
•Low “FODMAP” diet (ideally with dietician guidance)
•Trial of probiotic supplements for 4 weeks
1st line medications
Loperamide for diarrhoea
•Laxatives for constipation. Avoid lactulose as it can cause bloating. Linaclotide is a specialist laxative for patients with IBS not responding to first line laxatives
•Antispasmodics for cramps e.g. hyoscine butylbromide (Buscopan)
Second line meds
Tricyclic antidepressants (i.e. amitriptyline 5-10mg at night)
Third line meds
SSRIs antidepressants
therapy
Cognitive Behavioural Therapy (CBT) is also an option to help patients psychologically manage the condition and reduce distress associated with symptoms.