IBS

Question 1

define IBS

Answer 1

A functional bowel disorder defined as recurrent episodes of abdominal pain/discomfort (in the absence of detectable organic pathology) for > 6 months of the previous year, associated with two of the following: 
o	Altered stool passage  
o	Abdominal bloating  
o	Symptoms made worse by eating  
o	Passage of mucous

Question 2

what are the risk factors of IBS?

Answer 2

-visceral sensory abnormalities
- gut motility abnormalities
- psychosocial factors
- food intolerance
-

Question 3

epidemiology of IBS?

Answer 3

• common

- more common in females

Question 4

presenting symptoms of IBS?

Answer 4

• abdominal pain
• Altered bowel frequency
• abdominal bloating
• change in stool consistency
• passage with urgency
• tenesmus
• faecal urgency
• Feeling of incomplete stool evacuation

Question 5

what are the red flags symptoms?

Answer 5

o	Weight loss  
o	Anaemia  
o	PR bleeding  
o	Late onset (> 60 yrs)  
o	Family history of bowel or ovarian cancer 
- must exclude colonic malignancy

Question 6

what are the signs of IBS on physical examination?

Answer 6

• Usually NORMAL on examination

* Sometimes the abdomen may appear distended and be mildly tender on palpation in one or both iliac fossae

Question 7

what bloods should be done?

Answer 7

• FBC (anaemia)
• LFT
• ESR, CRP
• TFT
• anti-endomysial/anti-tranglutaminase antibodies (coeliac disease)

Question 8

what other examinations should be done for IBS?

Answer 8

• Stool examination: microscopy and culture for infective cause
• Ultrasound: exclude gallstone disease
• Urease breath test: exclude dyspepsia due to Helicobacter pylori
• Endoscopy: if other pathologies suspected

Question 9

what general diet advice should be given for IBS?

Answer 9

o	Have regular meals and take time to eat 
o	Avoid missing meals 
o	Drink 8 cups of fluid a day 
o	Restrict tea and coffee 
o	Reduce alcohol and fizzy drinks 
o	Reduce resistant starch intake in processed foods 
o	Limit fresh fruit 
o	Increase oat intake
o	Limit high fibre foods

Question 10

first line pharmaceutical treatment for IBS?

Answer 10

o Pain: antispasmodic agents
o Constipation: laxatives (not lactulose)
o Second-line for constipation post 12 months is linaclotide (cLOT)
o Diarrhoea: loperamide (sLOP)

Question 11

what is second line pharmaceutical treatment for IBS?

Answer 11

o Low dose tricyclic antidepressants (5-10)

Question 12

what are the complications of IBS?

Answer 12

• Physical and psychological morbidity

* Increased incidence of colonic diverticulosis

Question 13

what is the prognosis for patients with IBS?

Answer 13

• Chronic relapsing and remitting course of the disease

* Often exacerbated by psychosocial stresses