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EXAM 1 > IRRITABLE BOWEL SYNDROME (IBS) > Flashcards

IRRITABLE BOWEL SYNDROME (IBS) Flashcards

1
Q

What is the Epidemiology of IBS?

A
  • Common bet ages 20-30
  • *2 more in females than M
  • Affects 10-20%, under-report
  • *2 risk, 1st degree relatives
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2
Q

What is the Aetiology of IBS?

A
  • Exact cause = Unknown
  • Food intolerances e.g
    Lactose/ Gluten are
    precursors of IBS
  • No lesions present as gut
    not damaged or diseased
  • Stress

-Post infective bowel
dysfunction, gut
hypersensitivity, altered
colonic motility and
heightened pain sensation all
implicated

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3
Q

What is the pathophysiology of IBS?

A
  • Structurally = gut is normal
  • IBS is a ‘functional’ GI disorder
  • No detectable pathology using standard tests
  • Blood tests/stool samples/colonoscopy may be used to rule out other
    conditions
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4
Q

What are the symptoms of IBS?

A
  • Abdominal cramping
    *Diarrhoea/constipation/alternating
  • Flatulence, Bloating
  • Urgency to defecate
  • Acid indigestion
  • Nausea, Lethargy
  • Eating may worsen symptoms
  • Passing mucus in stools
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5
Q

How do you Diagnose IBS?

A
  • Abdominal pain present for at least 6 months
  • Relieved by defecation, or:
  • Increased/decreased bowel frequency or stool form
  • Plus at least 2 of the following:
  • Abdominal bloating/distension
  • Altered stool passage (straining, urgency, incomplete evacuation)
  • Worsened by eating
  • Passing mucus
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6
Q

How do you Diagnose IBS in secondary care using the Rome IV criteria?

A

Abdominal pain 1 day per week in last 3 months

Symptoms began at least 6 months prior

Alongside >2 of the following:
* Related to defecation
* Change in stool frequency
* Change in stool form

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7
Q

Describe the Classifications of IBS using the Rome IV Criteria?

A
  • IBS-C
    >25% of stools are types 1/2, <25% are types 6/7
  • IBS-D
    >25% of stools are types 6/7, <25% are types 1/2
  • IBS-M
    >25% of stools are types 1/2 AND >25% of stools are types 6/7
  • IBS-U
    Person has IBS, but bowel habits can’t be categorised as above
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8
Q

What are the treatments of IBS?

A
  • Antispasmodic drugs
  • Antidepressants
  • Laxatives
  • Loperamide
  • Linaclotide
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9
Q

What drug class is the Preferred treatment in IBS?

A

Direct acting smooth muscle relaxants

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10
Q

What are the 2 classifications of Antispasmodics?

A
  1. Antimuscarinics (anticholinergics)
  2. Smooth muscle relaxants
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11
Q

Give examples of direct acting smooth muscle relaxant drugs used to treat IBS, including their doses?

A
  • Alverine Citrate 60-120mg up to TDS
  • Mebeverine 135mg TDS (20 mins before food) or 200mg BD for MR preps
  • Peppermint oil capsules, 1-2 caps up to TDS
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12
Q

Give examples of antimuscarinic drugs used to treat IBS, including their doses?

A
  • Hyoscine butylbromide
  • Dicycloverine
  • C/I in intestinal obstruction or paralytic ileus
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13
Q

When can Anti-depressants be used in IBS?

A

-Use is unlicensed, for people with IBS pain

-People usually not responded to typical treatments

-Doses given are lower than you would see for mental health uses

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14
Q

Give examples of TCAs used in IBS and their doses?

A

Tricyclic antidepressants (TCA)

  1. Amitriptyline 10-30mg at night
  2. SSRI 2nd line (Sertraline, Citalopram, Fluoxetine)
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15
Q

Why should you counsel patients who take Anti-depressants for IBS?

A
  • COUNSEL patients as they may be shocked when reading PIL

-Pain modulatory effects/peripheral effects on GI function

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16
Q

What drug class can be used in IBS-C?

A

Laxatives

  • Dose should be titrated according to symptoms
17
Q

What drug laxative should NOT be used and why?

A
  • Lactulose

Lactulose can increase gas production and worsen symptoms

18
Q

What Laxative should be avoided in prolonged use in IBS?

A

Stimulant Laxative

19
Q

What drug class can be used in IBS-D?

A

Loperamide

20
Q

Who can buy Loperamide in IBS?

A

P/GSL versions of Loperamide can be used for Acute
diarrhoea in IBS, but only for patients >18 years old

Must have been diagnosed with IBS

21
Q

When should you not sell Loperamide but refer instead?

A

Only for attacks lasting up to 48 hours (refer if longer)

22
Q

What is the maximum time Loperamide can be used for?

A

Can be used for 2 weeks maximum, as long as individual bouts are less
than 48 hours

23
Q

What drug is used in patients with Moderate to severe IBS-C in adults?

A

Linaclotide

24
Q

When should Linaclotide be used in IBS-C?

A
  • Person must have had IBS-C for at least 12 months
  • Should only be used if max tolerated doses of laxatives haven’t helped
25
Q

What is the dosing of Linaclotide?

A

290mcg once daily 30 minutes before food

26
Q

When should Linaclotide be avoided?

A
  • Avoid in GI obstruction

*IBD

27
Q

What is the Pharmacology of Antispasmodics?

A
  • Exact mechanism of action for Mebeverine unknown
  • It specifically acts on smooth muscle cells
  • Blocks voltage operated sodium channels
  • This prevents build up of intracellular calcium
  • This reduces symptoms of colonic hypermotility
28
Q

What is the Pharmacology of Linaclotide?

A
  • Guanylate cyclase-c (GC-C) agonist
  • GC-C activation leads to increased production of cyclic guanosine
    monophosphate (cGMP)
  • Increased cGMP stimulates the cystic fibrosis transmembrane
    conductance regulator (CFTR) ion channel
  • CFTR ion channel increases secretion of chloride and bicarbonate into the intestinal lumen
  • GI transit increased

-GC-C = increases cGMP = increases CFTR action = increases intestinal chloride + bicarb

29
Q

What are the RED FLAG referral criteria’s for IBS?

A
  • Unintentional weight loss
  • Unexplained rectal bleeding
  • Family history of bowel/ovarian cancer
  • Loose stools for >6 weeks in patients >60 years old
  • Anaemia
  • Elevated inflammatory markers (?IBD)
  • Abdominal/rectal masses
30
Q
A

EXAM 1 (14 decks)

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