IBS

Question 1

What is IBS?

Answer 1

A function bowel disorder - no identifiable organic disease underlying symptoms. Symptoms are a result of abnormal functioning of a otherwise normal bowel.

Question 2

How do you diagnose?

Answer 2

Diagnosis of exclusion

Question 3

% population affected?

Answer 3

10-20%

Question 4

Symptoms suggesting IBS (NICE guidelines)?

Answer 4

• Abdo discomfort/pain relieved on defecation OR assoc. with change in bowel habits (form, frequency)
• AND 2 of:
• -> altered passage (straining vs. urgency)
• -> Bloating
• -> Worse eating
• -> passage of mucus

Question 5

Pathology to exclude (NICE guidelines)?

Answer 5

1) Normal FBC, ESR + CRP
2) Negative faecal calprotectin - excludes IBD
3) Negative coeliac screen (anti-TTG)
4) cancer not suspected OR excluded if suspected

Question 6

General management?

Answer 6

Advise there is no serious pathology:

• adequate fluids
• regular, small meals
• avoid processed food
• avoid caffeine + alcohol
• low FODMAP
• trial of probiotic supplements for 4 wks
• CBT

Question 7

1st line medication for:

a) diarrhoea
b) constipation
c) cramps

Answer 7

a) loperamide
b) laxatives - AVOID lactulose
c) hyoscine butylbromide (Buscopan)

Question 8

Medication if first line laxatives dont help constipation?

Answer 8

Linaclotide

Question 9

Second line medication?

Answer 9

Tricyclic antidepressant –> Amitriptyline 5-10mg at night

Question 10

3rd line medication?

Answer 10

SSRIs

Question 11

Symptoms that may indicate organic disease?

Answer 11

1) pain disturbs sleep
2) diarrhoea disturbs sleep
3) fever
4) PR bleed
5) weight loss