Irritable bowel syndrome (IBS)

Question 1

IBS is a “functional bowel disorder” - what does this mean?

Answer 1

No identifiable organic disease underlying the symptoms

Question 2

Name 3 signs/symptoms of IBS

Answer 2

• Diarrhoea
• Constipation
• Fluctuating bowel habit
• Abdominal pain
• Bloating
• Worse after eating
• Improved by opening bowels

Question 3

1) How can IBD be excluded as a cause of symptoms?
2) How can coeliac disease be excluded as a cause of symptoms?
3) Name 1 other pathology/test that must be excluded/normal before a diagnosis of IBS can be considered?

Answer 3

1) Negative faecal calprotectin (18-45 yo)
2) Negative anti TTG antibodies test (invalid in IgA deficiency, px also has to be eating gluten)
3) Normal FBC, ESR (erythrocyte sedimentation rate - marker of inflammation) and CRP blood tests, cancer not suspected

Question 4

1) Name a feature of the abdominal pain that implies a diagnosis of IBS
2) 2 of which 4 symptoms must also be present for a diagnosis of IBS?
3) These symptoms must persist for how long before a diagnosis of IBS can be made?

Answer 4

1) Relieved after opening bowels, associated with a change in bowel habits
2) Abnormal stool passage, bloating, worse symptoms after eating, PR mucus
3) 6 months

Question 5

Name 2 pieces of advice on diet that should be given to someone with a diagnosis of IBS?

Answer 5

• Adequate fluid intake
• Regular small meals
• Reduced processed foods
• Limit caffeine and alcohol

Question 6

First line medication
1) What is the first line medication for diarrhoea?
2) What is the first line laxative given in IBS?
3) For constipation, what laxative should be avoided and why?
4) What laxative is given to patients with IBS that don’t respond to the 1st line treatment?
5) What kind of drugs can be given for cramps, and name one

Answer 6

1) Loperamide
2) Bulk forming i.e. Ispaghula husk
3) Lactulose - bloating
4) Linaclotide
5) Antispasmodics i.e. hyoscine butylbromide, hyoscyamine, dicyclomine, mebeverine

Question 7

1) What is the 2nd line medication for IBS?
2) What is the 3rd line medication for IBS?
3) What else is an option for the treatment of IBS?

Answer 7

1) Tricyclic antidepressants
2) SSRI antidepressants
3) CBT and hypnotherapy