Irritable Bowel Syndrome (IBS)

Question 1

Are IBS and IBD the same?

Answer 1

NO

Question 2

How common is IBS?

Answer 2

Very common, ranges from mild-severe

Question 3

What is the main cause of IBS?

Answer 3

No clear cause

Question 4

Irritable Bowel Syndrome?

Answer 4

Motility in the gut

Question 5

What does an individual with IBS experience?

Answer 5

Individuals with IBS detect peristalsis and experience pain even if no food is in the gut

Question 6

What would you see in the diagnostic tests for a patient with IBS?

Answer 6

There would be no abnormality of structure or biochemistry

Question 7

What is the etiology of irritable bowel syndrome?

Answer 7

• Unclear

- Linked to lactose intolerance, diet, FODMAP, stress, smoking

Question 8

Peristalsis?

Answer 8

Motility in the gut

Question 9

Lactose intolerance?

Answer 9

The gut cannot process lactose, a carbohydrate, so the bacteria process it, producing gas as a byproduct.

Question 10

Which cells in the gut produce serotonin?

Answer 10

Enterochromaffin cells

Question 11

What does FODMAP stand for?

Answer 11

Fermentable, Oligosaccharide, Disaccharide, Monosaccharide and Polyols

Question 12

What are the 3 theories for IBS? (do not explain)

Answer 12

1. Motility and sensation
2. Serotonin signalling defect at molecular level
3. Fermentable, oligosaccharide, disaccharide, monosaccharide and polyols (FODMAPs)

Question 13

What is motility and sensation regulated by?

Answer 13

The nervous system

Question 14

Explain the following theory:

- Motility and sensation

Answer 14

Alteration or abnormality in the central nervous system regulation of GI motor and sensory function

Question 15

Serotonin?

Answer 15

Neurotransmitters that activate neurons in the bowels

Question 16

Which cells in the gut produce serotonin?

Answer 16

Enterochromaffin cells

Question 17

What is the 1. primary site of serotonin synthesis?

2. secondary site of serotonin synthesis?

Answer 17

1. Gut mucosa

2. nervous system

Question 18

The serotonin signalling defect affects the functions of serotonin resulting in the manifestations of IBS. Explain the functions/mnfts.

Answer 18

• secretion in the gut, resulting in excess mucous in gut-> mucoid stools
• serotonin involved in perfusion of bowels-> decreased function
• sensation in the gut-> pain

Question 19

List two examples of Polyols.

Answer 19

1. Sorbitol

2. ethanol

Question 20

What are the manifestations of IBS?

Answer 20

• abdominal discomfort and pain
• diarrhea or constipation (often alterations between both)
• flatulence
• nausea
• mucoid stool

Question 21

Flatulence?

Answer 21

Gas

Question 22

Diagnostics for IBS?

Answer 22

• by exclusion (must exclude obvious causes such as infection)
• labs (CBC, CRP, stool ova and parasites test)
• Gastroscopy
• Colonoscopy
• presentation -> if every test is negative, IBS is diagnosed by manifestations

Question 23

How is mild IBS treated?

Answer 23

No treatment. Pt can cope with symptoms by avoiding offending foods.

Question 24

How is severe IBS treated?

Answer 24

Drugs for symptomatic management , as well as avoiding offending foods and decreasing emotional stress

Question 25

Which drugs are used for the treatment of IBS?

Answer 25

• Antispasmodics
• Antidiarrheals and laxatives
• Antibiotics

Question 26

Why are antispasmodics used in the treatment of IBS?

Answer 26

They inhibit bowel spasms to relieve discomfort and pain

Question 27

Why are antidiarrheals and laxatives used in the treatment of IBS?

Answer 27

They help with alternating bowel pattern

Question 28

Why are antibiotics used in the treatment of IBS?

Answer 28

No bacterial infection however, they are used to manage the normal flora in the gut to minimize the production of flatulence as a byproduct of digesting polyols and lactose.

Question 29

What is important to note when prescribing antibiotics as a treatment for IBS?

Answer 29

You do not want to eliminate the normal flora in the gut, just control an overgrowth. Therefore, pt should only be on antibiotics for a short-term and on a low dose.