Irritable Bowel Syndrome

Question 1

What is irritable bowel syndrome?

Answer 1

Chronic disorder affecting the large intestine leading to cramping, abdominal pain, bloating, gas and diarrhoea or constipation.

Question 2

What are the criteria for CONSIDERD diagnosis of IBS to be made?

Answer 2

(At least 6 months of)
Abdominal pain and/or
Bloating and/or
Change in bowel habit

Question 3

What are the criteria for a POSITIVE diagnosis of IBS to be made?

Answer 3

POSITIVE DIAGNOSIS IF:
Abdominal pain relieved by defecation or associated with altered bowel frequency or stool for + 2/4 of:
Altered stool passage (straining, urgency, incomplete evacuation)
Abdominal bloating
Symptoms made worse by eating
Passage of mucus

Question 4

What are additional features which may be present in IBS?

Answer 4

Lethargy
Nausea
Backache
Bladder symptoms

Question 5

What red flag symptoms should be enquired about in IBS to exclude more sinister conditions?

Answer 5

Rectal bleeding
Unexplained/unintentional weight loss
FHx of bowel or ovarian cancer
Onset >60 years of age

Question 6

What are the primary care investigations of IBS?

Answer 6

Full blood count
ESR/CRP
Coeliac disease screen (tissue transglutaminase antibodies)

Question 7

What are the pharmacological management options for IBS?

Answer 7

Pain: antispasmodic agents
Constipation: laxatives but avoid lactulose
Diarrhoea: Loperamide

Question 8

For patients with constipation associated with IBS, when might linaclotide be considered?

Answer 8

Conventional options not helped

Constipated for at least 12 months

Question 9

What is the second-line pharmacological treatment of IBS?

Answer 9

Low-dose tricyclic antidepressants (e.g. amitriptyline 5-10 mg)

Question 10

What are non-pharmacological management options for IBS?

Answer 10

Psychological interventions - CBT, hypnotherapy, psychological therapy (If no response for 12 months - refractory IBS)

Question 11

What is the general dietary advice for IBS?

Answer 11

Have regular meals and take time to eat
Avoid missing meals or leaving long gaps between eating
Drink at least 8 cups of fluid per day
Restrict caffeine 
Avoid alcohol and fizzy drinks
Consider limiting high-fibre food
Reduce intake of resistant starch
Limit to 3 portions of fruit per day
Eat oats