Irritable Bowel Syndrome

Question 1

Psychosocial factors affect functional gastrointestinal disorders and vice versa

Answer 1

Life stress, psychological stress, coping, social support

Question 2

Physiological factors affect functional gastrointestinal disorders and vice versa

Answer 2

Motility, sensation, inflammation, altered bacteria flora

Question 3

What is the diagnostic criteria for irritable bowel syndrome?

Answer 3

Rome III diagnostic criteria

Question 4

Rome III diagnostic criteria

Answer 4

Recurrent abdominal pain or discomfort at least 3 days per month associated with 2 or more of the following:
o Improvement with defecation
o Onset associated with a change in frequency of stool
o Onset associated with a change in form of stool
Criterial fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis

Question 5

When is further evaluation necessary?

Answer 5

> 50 years old, weight loss, blood in stools, anaemia, fever, short history of progressive pain

Question 6

Risk factors for irritable bowel syndrome

Answer 6

<45 years old, female, family history of IBS, have mental health problem

Question 7

Diagnosis of irritable bowel syndrome

Answer 7

Exclude organic disease relevant to patient

Question 8

Foods that can aggravate symptoms of IBS

Answer 8

Brassicas, pulses, onions, garlic, mushrooms, seeds

Question 9

Antispasmodics:

• What to they do?
• Examples

Answer 9

• Provide short/medium term relief of pain/discomfort but should be used refractory
• Mebeverine, alverine citrate, peppermint oil

Question 10

Fibre as the treatment for irritable bowel syndrome

Answer 10

Soluble fibre supplements - ispaghula

Question 11

Examples of osmotic laxatives

Answer 11

Polyethene glycol, lactulose, milk of magnesia

Question 12

IBS-D treatment

Answer 12

Diet, antispasmodics, anti-diarrhoeals, anti-depressants, anti-convulsant analgesics

Question 13

IBS-C treatment

Answer 13

Diet, antispasmodics, fibre, osmotic laxatives, 5-HT4 receptor agonists, guanylate cyclase agonist, selective C-2 chloride channel activators

Question 14

Dietary advice for IBS

Answer 14

Keep a food and symptom diary, ensure adequate fluid intake, eat 3 regular meals a day, choose smaller meals, take time to eat meals and chew food well, take time to relax

Question 15

Things to avoid in IBS

Answer 15

Cut down on rich or fatty food and processed meals, avoid skipping meals, don’t eat late at night, limit fresh fruit to 3 portions a day, limit alcohol intake, caffeine intake and fizzy juice intake

Question 16

Second line treatment in IBS

Answer 16

Low FODMAP diet

Question 17

What are FODMAPs?

Answer 17

A group of short chain carbohydrates that are poorly digested in the small bowel leading to fermentation and osmotic changes in the large bowel

Question 18

What does FODMAP stand for?

Answer 18

F = fermentable
O = oligo-saccharides
D = disaccharides
M = monosaccharides
A = and
P = polypols

Question 19

3 stages of low FODMAP diet

Answer 19

Elimination - temporary restriction of high FODMAP foods, usually 2-6 weeks, maximum 8 weeks
Reintroduction - challenging each FODMAP group in specified quantities to identify trigger foods
Customisation - introducing non-trigger foods to liberties diet