Psychosomatics: the example of Irritable Bowel Syndrome

Question 1

define the term psychosomatic disorder

Answer 1

psychosomatic disorders are disorders where emotional or psychological factors can impact on the symptoms

Question 2

give me some examples of psychosomatic disorders

Answer 2

• asthma
• atopic dermatitis
• tension-type headache
• chronic fatigue syndrome
• IBS

Question 3

What is the most common functional GI disorder encountered in primary and secondary care

Answer 3

IBS

Question 4

what is a functional GI disorder

Answer 4

disorders of the gut-brain interaction, classified by GI symptoms

Question 5

symptoms of IBS

Answer 5

• Stomach pain or cramps (worse after eating and better after moving your bowels)
• bloating
• diarrhoea
• constipation
  come and go over time but is a chronic condition

Question 6

what is IBS thought to be linked to

Answer 6

food passing though your gut too quickly or too slowly, oversensitive nerves in your gut and a family history of IBS

Question 7

how do we diagnose IBS

Answer 7

by the roman IV criteria
in the last 3 months, with symptom onset at least 6 months prior to diagnosis the individual experiences recurrent abdominal pain at least 1 day/week in the last three months associated with 2 or more of the following
- related to defecation
- associated with a change in frequency of stool
- associated with a change in form (appearacnce of the stool)

PLUS TWO OF THE FOLLOWING

• a change in how you pass stools (urgency etc)
• bloating, hardness or tension in abdomen
• symptoms worse after eating
• passing mucus from the rectum

Question 8

Technicalities behind an IBS diagnosis

Answer 8

almost purely based off symptoms as we don’t know the causes however tests are done to exclude other conditions such as coeliacs disease with a blood test and calprotectin for IBD in a stool sample

Question 9

IBS impact on patients

Answer 9

• work
• visits to healthcare professionals
• health related quality of life
• psychological health

Question 10

putative causes of IBS - BIOLOGICAL

Answer 10

• abnormal muscle contraction
• serotonin receptors
• infection
• food intolerance

Question 11

psychological causes of IBS

Answer 11

• psychological discord’s
• psychiatric disorders
• hyper-reactivity in the brain-gut interface
• stressful life events

Question 12

social causes of IBS

Answer 12

• adverse childhood experiences

- social learning

Question 13

how do we manage IBS

Answer 13

• diet/lifestyle (physical activity) changes approach
• drug treatments approach
• psychological approaches
• complementary therapies approach

Question 14

diet/lifestyle changes

Answer 14

• food diary
  identify food intolerances and whether the diet is healthy
• asses activity levels

Question 15

drug treatments for IBS - first line

Answer 15

TREAT THE SYMPTOMS

• antidiarrhoeal (loperamide)
• laxatives (not lactulose)
• antispasmodics

Question 16

drug treatments for IBS - second line

Answer 16

• antidepressants
  TCAs (if first line ineffective)
  SSRIs (if TCAs ineffective)
• laxatives (linaclotide only if previous laxatives have not worked)

Question 17

complementary therapies in the treatment of IBS

Answer 17

• nutraceuticals
• Chinese herbal medicine
• probiotics

NOT RECOMMENDED

• acupuncture
• reflexology

Question 18

If after 12 months there is no improvement then what psychological approaches are taken

Answer 18

• cognitive behavioural therapy
• hypnotherapy
• psychological therapy

Question 19

communication aims when delivering a dignosis

Answer 19

be optimistic but realistic 
- reduce disability 
- improve coping 
- reduce dependance on healthcare 
LISTEN TO YOUR PATIENT