Irritable Bowel Syndrome Flashcards
What is IBS
Relapsing functional bowel disorder associated with a change in bowel habit -> No organic cause found
Group of symptoms/not specific
Describe stools in IBS
Hard, soft and mixed stool
Clinical presentation of IBS
Crampy abdominal pain relieved by defecation or wind
Altered bowel habit
Sensation of incomplete evacuation (tenesmus)
Abdominal bloating
Distension
Change in bowel habit i.e. increased or decreased frequency
Pathophysiology of IBS
Broadly unknown
No organic cause can be found
Aetiology of IBS
No structural lesion
Broadly unknown
Associated with psychological stress
Possibly related to increased sensitivity of the gut and problems digesting food
Epidemiology of IBS
More common in women
10-20% prevalence
age of onset often less than or around 40
Diagnosis of IBS
NOT a diagnosis of exclusion
*Coeliac screen
Treatment of IBS
Regular meals
Lots of fluids
Fibre depends on type; more with diarrhoea, less with constipation
Placebo has strong effect
Signs of IBS
examination may be normal, but general abdominal tenderness is common
insufflation or air during lower GI endoscopy (not usually needed) may reproduce pain
Management of IBS - when to refer patient
Uncertain of diagnosis
Changing symptoms
Refractory symptoms - stress or depression
Order of treatment
Should focus on controlling symptoms
Initially using lifestyle/dietary measures
Then cognitive therapy or pharmacotherapy if required
Treatment of constipation associated
Ensure adequate water and fibre intake
Promote physical activity
Simple laxatives
Treatment of diarrhoea
avoid sorbitol sweeteners, alcohol and caffeine
reduce dietary fibre content
encourage patients to identify their own ‘trigger foods’
try a bulking agent maybe with loperamide after each loose stool
Treatment of colic/bloating
Oral antispasmodics (e.g. mebeverine)
Treatment of psychological symptoms/visceral hypersensitivity
Emphasise the positive
Consider CBT
