Irritable bowel syndrome and Antispasmodics

Question 1

1) IBS commonly affects people between which age?

2) who are commonly affected: males or females?

Answer 1

1) Mainly affecting people aged between 20 and 30 years

2) Females

Question 2

list the symptoms of IBS

Answer 2

1) Abdominal pain or discomfort,
2) Disordered defaecation
3) Passage of mucus
4) Bloating

Question 3

how are symptoms generally relieved in IBS?

Answer 3

relieved by defaecation

Question 4

Diet and lifestyle changes are important for effective self-management of IBS. what advice should be provided to patients?

Answer 4

1) Increase physical activity
2) Eat regularly, without missing meals or leaving long gaps between meals
3) limiting fresh fruit consumption to no more than 3 portions per day. consume soluble fiber
4) Fluid intake: at least 8 cups each day and the intake of caffeine, alcohol and fizzy drinks reduced
5) Artificial sweetener sorbitol should be avoided in patients with diarrhoea
6) probiotics

Question 5

1) If an increase in dietary fiber is required in patients with IBS what should be recommended?
2) what should be avoided?

Answer 5

1) soluble fibre such as ispaghula husk. foods high in soluble fibre include oats
2) insoluble fibre (e.g. bran) and ‘resistant starch’ should be reduced or discouraged as they may exacerbate symptoms.

Question 6

If probiotics are being used in IBS, how long should the taken for before evaluating their effect?

Answer 6

continue for at least 4 weeks while monitoring the effect.

Question 7

outline the pharmacological treatment of IBS

Answer 7

1) Antispasmodics in addition to dietary and lifestyle changes
2) A laxative (NOT lactulose ) for constipation
3) Anti-motility drug for relief of diarrhoea. Loperamide hydrochloride is the first-line
4) A low-dose tricyclic antidepressant e.g. Amitriptyline for abdominal pain or discomfort as a second-line option in patients who have not responded to antispasmodics, anti-motility drugs, or laxatives. SSRIs if TCA’s fail

Question 8

list 3 Antispasmodics

Answer 8

1) Alverine citrate
2) Mebeverine hydrochloride
3) Peppermint oil

Question 9

why should lactulose not be used in IBS?

Answer 9

It can cause bloating

Question 10

when can linaclotide be considered in IBS?

Answer 10

Patients who have not responded to laxatives from the different classes and who have had constipation for at least 12 months

Question 11

when can Psychological intervention be offered to patients with IBS?

Answer 11

patients who have no relief of IBS symptoms after 12 months of drug treatment.