Psychosomatic IBS

Question 1

Define the term Psychosomatic Disorder.

Answer 1

Disorders where emotional and psychological factors can impact on symptoms and their severity.

Question 2

What is a Functional Gastrointestinal Disorder (FGID)?

Answer 2

Disorders of the gut-brain interaction. Classified by GI symptoms related to any combination of the following: motility disturbance, visceral hypersensitivity, altered mucosal and immune function, altered gut microbiota and altered CNS processing.

Question 3

What are the Rome IV Criteria?

Answer 3

That in the last 3 months, with symptom onset at least 6 months prior to diagnosis, the individual experiences recurrent abdominal pain at least one day per week in the last 3 months and it is associated with two or more of the following;

- related to defecation,
- associated with a change in frequency of stool,
- associated with a change in form/appearance of stool.

Question 4

What are the possible biological causes of IBS?

Answer 4

• abnormal muscle contraction - more easily stimulated, stronger muscle or more frequent.
• number of serotonin receptors - SSRIs can alleviate symptoms for some patients.
• infection - 6x greater risk
• food intolerance - exclusion diets can be helpful

Question 5

What are the possible psychological causes of IBS?

Answer 5

• Psychological disorders - depression and anxiety thought to precede.
• Psychiatric disorders

Question 6

What are the possible social causes of IBS?

Answer 6

• Stressful life events
• Adverse childhood experiences
• Social Learning - copying others

Question 7

What are the different stages of management of IBS?

Answer 7

• Diet/Lifestyle Change
• Drug Treatment
• Complementary Therapies
• Psychological Approaches

Question 8

What is the first line of drug treatment for IBS?

Answer 8

• Antidiarrhoeal (Loperamide)
• Laxatives (not Lactulose)
• Antispasmodics (if pain is significant).

Question 9

What is the second line of drug treatment for IBS?

Answer 9

• Antidepressants - Tricyclic Antidepressant (TCA) and if that doesn’t work Selective Serotonin Reuptake Inhibitors (SSRIs).
• Laxatives (Linaclotide; if others didn’t work).

Question 10

What are the complementary therapies recommended for IBS treatment?

Answer 10

• Nutraceuticals - peppermint oil capsules and plant based compounds
• Chinese Herbal Medicine
• Probiotics

NOT RECOMMENDED - acupuncture and reflexology.

Question 11

What are the psychological approaches of treating IBS?

Answer 11

• Behavioural Therapy - targets behaviour e.g. urgency
• Hypnotherapy - reduces threatening stimuli
• Psychological therapy - effective for people with adverse childhood experience