IBS

Question 1

mainly affects this age range

Answer 1

20-30 yr olds

Question 2

more common in

Answer 2

women

Question 3

symptoms

Answer 3

• abdominal pain or discomfort
• disordered defecation (e.g. either diarrhoea, or constipation with straining, urgently and incomplete evacuation)
• mucus in poo
• bloating

Question 4

non drug treatment

Answer 4

• increase physical activity
• eat regularly without missing meals or leaving long gaps between meals
• limit fresh fruit consumption to max 3 portions a day
• review fibre intake - if increase required, recommend soluble fibre e.g. isphagula husk or foods high in soluble fibre e.g. oats
• insoluble fibre e.g. bran and resistant starch should be discouraged as it may exacerbate symptoms
• increase fluid intake to at least 8 cups a day
• reduce caffeine, alcohol, fizzy drinks
• avoid sorbitol in pt with diarrhoea

Question 5

probiotics

Answer 5

if being used, continue for at least 4 weeks while monitoring effects

Question 6

if symptoms persist following lifestyle and dietary advice

Answer 6

single food avoidance and exclusion diets may be an option under supervision of dietician or medical specialist

Question 7

name antispasmodics

Answer 7

peppermint oil
alverine citrate
mebeverine hydrochloride

Question 8

which laxative is not recommended in IBS

Answer 8

lactulose - can cause bloating which can worsen symptoms

Question 9

drug treatment

Answer 9

• depends on nature and severity of symptoms
• antispasmodics can be taken in addition to diet and lifestyle changes
• laxative can be used for constipation (not lactulose due to bloating)
• loperamide for anti-diarrhoea relief

Question 10

when can linaclotide be offered

Answer 10

• if pt has not responded to laxatives from different classes and have has constipation for at least 12 months
• this is indicated for moderate to severe irritable bowel syndrome with constipation

Question 11

dose of linaclotide

Answer 11

290 micrograms once daily, dose to be taken at least 30 minutes before meals, review treatment if no response after 4 weeks.

Question 12

Low dose TCA e.g. amitriptyline and SSRI

Answer 12

(unlicensed indication)
- Can be used for abdominal pain or discomfort as 2nd line option in pt who have not responded to antispasmodics, anti-motility drugs or laxatives
- SSRI may be considered in those who don’t respond to TCA

Question 13

Mebeverine OTC

Answer 13

• for symptomatic relief of IBS; max single dose is 135mg and max daily dose If TDS (405mg)
• for uses other than symptomatic relief of IBS; max single dose 100mg, max daily dose 300mg

Question 14

dose of mebeverine 200mg MR for IBS

Answer 14

200mg BD

Question 15

mebeverine contraindication

Answer 15

paralytic ileus

Question 16

Mebervine in pregnancy and BF

Answer 16

avoid

Question 17

peppermint oil - how to take

Answer 17

do not break or chew caps as peppermint oil can irritate mouth or oesophagus

Question 18

Dose for peppermint oil

Answer 18

1-2 caps TDS, up to 3 months if necessary
Mintec brand: take before meals

Question 19

peppermint oil caution

Answer 19

sensitivity to menthol

Question 20

SE peppermint oil

Answer 20

• Ataxia
• Bradycardia
• GI discomfort
• n/v
• GORD
• Headache
• Paraesthesia
• Rash erythematous
• Tremor

Question 21

Alverine dose

Answer 21

60-120mg one to three times a day

Question 22

Label alverine

Answer 22

can make you dizzy - can affect performance of skilled tasks

Question 23

alverine contraindications

Answer 23

intestinal obstruction
paralytic ileus