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GI - anna > Irritable bowel syndrome (IBS) > Flashcards

Irritable bowel syndrome (IBS) Flashcards

1
Q

what two types of criteria differentiates the severity of IBS

A

Rome IV criteria

Manning criteria

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2
Q

incidence greater in

A

younger patients <45 onset but persists to old age
are female
have a family history of IBS
have a mental health problem (anxiety, depression)

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3
Q

what are the 4 IBS’s presentations

A

IBS-C (constipation)
IBS-D (diarrhoea)
IBS-M (mixed)
IBS-P (pain)

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4
Q

what is used to describe stool form

A

bristol stool chart

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5
Q

what is essential in the diagnosis of IBS

A

history:
do symptoms fit criteria, travel/infective/malbsorptive, dietary, antibiotic, FH of IBD/CRC/autoimmune/endocrine, developmental, psychosocial, medicines)

examination (nutritional status, anaemia, EIM of IBD, masses, PR)
normal FBC in absence of ‘redflags’ in <50 yo

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6
Q

what are the investigation options for IBS

A

Pragmatic:
PV/CRP, TSH, TTG, (faecal calprotectin, FIT)
consider AXR selectively

Positive history (i.e. probably more than IBS):
endoscopic/histopathological colonic evaluation
X-sectional imaging
H+ breath test
14C-glycocholic acid breath test/SeHCAT test
faecal elastase/‘trial of creon’
gut hormones

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7
Q

treatment of IBS (VRI)

A

validate - uncomfortable and inconvenient
reassure - IBS benign with good prognosis and normal lifespan
inform - chronic fluctuating disease, diagnosis wont change

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8
Q

what diet will be best for IBS

A 
maintain healthy with fruit and veg
increase carefully
skins and seeds may irritate symptoms
some may ferment - gas - bloating/pain (brassicas, pulses, onions, garlic, mushrooms)
it it upsets you dont eat it
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9
Q

what do antispasmodics in IBS-C do

A

may not work well - decrease moltility
short/medium term relief of pain/discomfort
eventually refractory - use intermittently
odified release preparations

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10
Q

give examples of antispasmodics in IBS-C

A 
mebeverine (colofac), alverine citrate (spasmonal)
peppermint oil (colpermin) - decrease bloating
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11
Q

what does fibre do for IBS

A 
soluble fibre supplements effective
- ispaghula (fybogel, UK)
- psyllium (metamucil, USA)
absorbs lumenal water - swells = bulk
sometimes contains anti-spasmodic
can also be effective for mild diarrhoea symptoms
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12
Q

osmotic laxatives examples

A

polyethylene glycol
lactulose
MgOH (milk of magnesia)
stimulant laxatives (short term)

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13
Q

what does polyethylene glycol do

A

less s/e bloating, pain

NaHCO3, NaCl, KCl prevents water absorption, improvs constipation but not pain

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14
Q

what does 5-HT4 receptor agonists do and examples

A

tegaserod - for pain, bloating and constipation in IBS-C and CIC
stimulates enteric nervous system, increases peristalsis, alleged analgesic effect

prucalopride - Chronic Idiopathic Constipation in women

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15
Q

examples and MoA of guanylate cyclase agonist

A

linaclotide (constella)

peptide agonist of guanylate cyclase 2C
increases intracellular cclic GMP
increased intestinal secretion and transit
reducing abdominal pain
2 large RCTs
longterm effects unknown
limited to failure/intolerance PEG laxatives

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16
Q

example and MoA of selective c-2 choloride channel activators

A

lubiprostone (amitiza, 24mcg od -bd)
>placebo for global IBS-C symptoms in women
IBS-C, CIC and opiate-induced
bicyclic fatty acid derived from prostagandin E
chronide rich secretion
soften stool, increase motility and promote SBMs

17
Q

How to stop diarrhoea IBS-D

A

symtpoms attributed to certain foods/beverages
- limit fruit. juices / pith/skins / veg>fruit
try reducing bran fibre and increase soluble fibre foods

18
Q

what antispasmodics in IBS-D

A 
short/medium term relief of pain
eventually refractory 
modified release preparations
mebeverine (colofac), alverine citrate (spasmonal)
peppermint oil - decreases bloating
19
Q

named and decribe the function of some anti-dairrhoeals

A

loperamide

  • reduces stool freuency
  • improves consitency
  • no better than placebo: pain/bloatig
  • no long term data or comparative trials

codeine phsophate
- effective/should be avoided

20
Q

name a 5-HT3 receptor antagonist used in IBS-D

A

alosetron

21
Q

why are anti-depressants used

A

role to play in gut motility

22
Q

what anti-depressants are used

A

tricyclics (amitriptyline, nortriptyline)

SSRI’s

23
Q

what anti-convulsant analgesics are used

A

gabapentin

pregabalin (beneficial effect on anxiety component

24
Q

what are the psycological therapies of IBS

A 
CBT
dynamic psycotherapy
hypnotherapy
herbal remedies
acupuncture

GI - anna (14 decks)

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