IBS

Question 1

What are the risk factors for IBS development ?

Answer 1

• Young < 45
• Female
• Fam history of IBS
• Has a mental disorder or history of physcial/sexual abuse - e.g. anxiety, depression, or a personality disorder

Question 2

What is the clinical criteria of symptoms which are used to help diagnose IBS ?

Answer 2

If the patient has abdo pain/discomfort that is either relieved by defaecation or is associated with altered bowel frequency/stool form for ≥ 6 months.

This should be accompanied by ≥ 2 of the following:

1. Altered stool passage (straining, urgency, incomplete evacuation)
2. Abdo bloating - distension, tension or hardness
3. Symptoms made worse by eating
4. Passage of mucus

Note - altered stool form may be constipation, diarrhoea or mucus

Question 3

What additional features may support a diagnosis of IBS ?

Answer 3

• Lethargy
• Nausea
• Backache
• Bladder symptoms

Question 4

What red flag symptoms should you ensure someone with possible IBS does not have and what should be done if so ?

Answer 4

• Rectal bleeding
• Unexplained/unintentional weight loss
• Family history of bowel or ovarian cancer
• onset after 60 years of age (as cancer more likely now)
• Raised inflam markers - suggestive of IBD

Basically screen for cancer symptoms and IBD, if they do have any then send for further investigation such as endoscopy & H+ breath test etc

Question 5

What inital investigations should you do for someone with possible IBS to rule out other potential diagnoses ?

Answer 5

• FBC
• Inflam markers - ESR & CRP to rule out IBD
• IgA-TTG or IgA-EMA to rule out coeliacs disease

Question 6

What is the diagnosis of IBS made on the basis of ?

Answer 6

If someone meets the clinical criteria of IBS & other potential diagnoses have been ruled out (IBD & coeliacs) & they have no red flags of cancer needing further investigation

Question 7

Over what age is a diagnosis of IBS unusual ?

Answer 7

>50

Question 8

What general dietry advice is given to people with IBS ?

Answer 8

• Have regular meals and take time to eat
• Avoid missing meals or leaving long gaps between eating
• Drink at least 8 cups of fluid per day, especially water
• Restrict tea and coffee to 3 cups per day
• Reduce intake of alcohol and fizzy drinks
• Consider limiting intake of high-fibre food e.g. wholemeal or high-fibre flour and breads, cereals high in bran, and whole grains such as brown rice
• Reduce intake of ‘resistant starch’ often found in processed foods
• Limit fresh fruit to 3 portions per day
• For diarrhoea, avoid sorbitol
• For wind and bloating consider increasing intake of oats e.g. oat-based breakfast cereal or porridge and linseeds
• For bloating/pain (brassicas, pulses, onions, garlic, mushrooms) ferment = gas = bloating/pain

Question 9

If someone with IBS needs to increase their dietry fibre then what should be used ?

Answer 9

Soluble fibre supplements e.g. ispaghula (fybogel)

Question 10

What is the 1st line pharmacological management of IBS ?

Answer 10

• 1st line for pain = antispasmodic agent e.g. buscopan, meberverine, alverine citrate, peppermint oil
• 1st line for contipation = laxatives e.g. polyethylene glycol, MgOH
• 1st line for diarrhoea = loperamide

Question 11

What is peppermint oil also good for besides pain ?

Answer 11

Decreasing bloating

Question 12

What laxatives should be avoided in IBS ?

Answer 12

Lactulose and stimulant laxatives e.g. senna, ducloax

Question 13

What is the 2nd line option for contipation in IBS when previous laxatives have not helped & the patient has had constipation for 12 months ?

Answer 13

Linaclotide

Question 14

If laxatives, loperamide or anti-spasmodics have not worked what are the 2nd line pharmacological options for IBS ?

Answer 14

• 1st line = tricyclic anti-depressant (TCA) e.g. amitriptyline or nortriptyline
• 2nd line = SSRI only if TCA ineffective

Question 15

What is the 3rd line option in the management of IBS and when is it used?

Answer 15

CBT, hyponetherapy &/or psychological therapy for those who do not respond to pharmacological treatment s after 12 months