IBS

Question 1

What is iBS?

Answer 1

Group of bowel disorders characterized by bloating and pain associated with defecation
OR
change in bowel habit where symptoms have lasted 6 months with symptoms at least 3 days per month in the last 3 months

Question 2

What Causes IBS?

Answer 2

Motor or sensory dysfunction in the GI tract which alters gut reactivity and dysregulation of brain-gut axis
Can be associated with stress

Question 3

Who gets it?

Answer 3

• Acute bacterial gastroenteritis
• Emotional stimuli
• TWICE as likely in women
• Fam history

Question 4

Requirements of IBS?

Answer 4

Recurrent pain or discomfort which
+
-Improves with defecation
-is associated with change in form of stool,
- is associated with change in frequency of stool

Question 5

Presentation of IBS?

Answer 5

• Diarrhoea
• Constipation
• Fluctuating bowel habits
• Abdominal pain
• Bloating
• Worse after eating
• Improved by evacuating bowels

Question 6

Diagnosis of IBS?

Answer 6

Exclude if there is any organic disease (DIAGNOSIS OF EXCLUSION)
Gather history and examination
Normal FBC, if no red flags and under 50

Question 7

How is IBS treated?

Answer 7

Diet modifications: fibre, caffeine, regular meals, food diary
Exercise
Reducing stress
Medication

Question 8

Medications to treat IBS?

Answer 8

Anti-spasmodics - reduce pain & cramping
Laxatives: relieve constipation
Anti-motility: relieve diarrhoea
Low dose antidepressants: can reduce stomach pain & cramping
Reduce/stop opioid analgesics

Question 9

Criteria for diagnosis- What should be excluded?

Answer 9

• Normal FBC, ESR & CRP blood tests
• Faecal calprotectin negative to exclude IBD
• -ve coeliac serology (TTG)
• Cancer not suspected

Question 10

Criteria for diagnosis- symptoms suggesting IBS?

Answer 10

3 month history of abdominal pain and/or discomfort for atleast 3 days per week that is:

• Relieved on defaecation
• Associated with change in stool frequency
• Associated with change in stool consistency

Question 11

Medication for diarrhoea?

Answer 11

Loperamide is first line