IBS

Question 1

What are the symptoms of IBS?

Answer 1

• abdo pain relieved on defaecation/associated with altered bowel habit
• altered stool passage (straining, urgency, incomplete evacuation)
• bloating
• worse on eating
• mucous passage

Question 2

When should a diagnosis of IBS be considered? What’s the criteria?

Answer 2

consider diagnosis @ altered bowel habit + pain for 6 months

criteria = abdo pain relieved on shitting/with altered stool + 2 of:

• bloating
• altered passage
• worse on eating
• passage of mucous

Question 3

What investigations should be done for IBS?

Answer 3

• all of them - it’s a diagnosis of exclusion
• colonoscopy if >50 for Ca
• coeliac screen
• biopsy if increased frequency is a Sx

Question 4

treatment of IBS-D, IBS-C and IBS-M? What helps with IBS pain?

Answer 4

D = loperamide 
C = laxatives (no lactulose)
M= give both lol 

Pain = anti-spasmodic (mebeverine)

Question 5

What can be used second-line in IBS?

Answer 5

• tricyclic - amytriptilline
• linaclotide - used for refractory constipation at 12 months
• CBT, psychodynamic at 12 months also

Question 6

Dietary advice for IBS?

Answer 6

Explore dietary triggers and refer to a dietician
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 (water or herbal tea)
Restrict tea and coffee to 3 cups per day
Reduce intake of alcohol and fizzy drinks
Consider limiting intake of high fibre food (wholemeal and whole grains)
Reduce intake of ‘resistant starch’ often found in processed foods
Limit fresh fruit to 3 portions per day
For diarrhoea – avoid sorbitol (found in some fruits)
For wind and bloating – consider increasing intake of oats and linseeds