IBS

Question 1

What is the Rome Diagnostic criteria for IBS?

Answer 1

• recurrent abdominal pain/discomfort for 3 days of the month

Assoc. with:

• improves with defecation
• change in stool freq.
• change in form/appearance of stool

Question 2

If a patient presents with symptoms of IBS, what other criteria would make you investigate further?

Answer 2

Further evaluation if >50 or has any of:

- weight loss
- blood in stools
- anaemia
- fever
- short history of progressive pain

Question 3

What is involved in the Manning criteria for IBS?

Answer 3

• pain relieved on defecation
• more freq. and looser stools at onset of pain
• visible bloating/ abdominal distension
• passage of mucus
• tenesmus (feels incomplete)

Question 4

What investigations would you consider doing for patients who present with symptoms of IBS?

Answer 4

• inflammatory markers (PV/ CRP)
• TTG (coeliac)
• faecal calprotectin
• AXR in selected people
• H+ breath test
• cross sectional imaging

Question 5

What dietary measures are recommended for the treatment of IBS?

Answer 5

• healthy intake of fruit and vegetables
• skins and seeds may irritate symptoms
• Some foods may ferment gas/ bloating/
  pain (e.g. pulses, onions, garlic, mushrooms)
• If it upsets you, don’t eat it

Question 6

Give examples of antispasmodics which can be used in IBS?

Answer 6

• Mebeverine (Colofac)
• Alverine citrate (Spasmonal)
• Peppermint oil (Colpermin) - decreases bloating

Question 7

How is fibre added to the diet in patients experiencing IBS?

Answer 7

• bran fibre often ineffective

=> soluble fibre supplements effective:
E.g. ispaghula (Fybogel)

• absorb water to bulk up stool

Question 8

Osmotic laxatives do not help symptoms of pain in IBS. TRUE/FALSE?

Answer 8

TRUE

• prevents water absorption
• improves constipation but not pain

Question 9

Stimulant laxatives should be avoided in IBS patients/ TRUE/FALSE?

Answer 9

TRUE

• avoid
• only infrequent short term use

Question 10

What anti-diarrhoeals can be used in IBS?

Answer 10

loperamide

- reduces stool frequency
- improves consistency

codeine phosphate

- effective
- should be avoided if dependence

Question 11

What antidepressants can be used in IBS?

Answer 11

• tricyclics (amitriptyline, nortriptyline)

- SSRI’s

Question 12

What anti-convulsant analgesics can be used in IBS?

Answer 12

gabapentin

pregabalin (beneficial in anxiety component)

Question 13

Why are pro-biotics thought to be useful in IBS?

Answer 13

• to alter the gut microbiota

Question 14

What psychological and alternative therapies can be used for IBS treatment?

Answer 14

• CBT
• dynamic psychotherapy
• hypnotherapy
• Herbal remedies
• acupuncture