Irritable Bowel Syndrome

Question 1

Define irritable bowel syndrome as per Rome III criteria

Answer 1

Recurrent abdo pain for 3 days/month for 3 months
\+ at least 2 of
Improvement with defecation
Change in stool frequency
Change in stool appearance

Question 2

Is IBS an acute or chronic presentation?

Answer 2

Chronic - has been going on for months

Question 3

Who is more commonly affected by IBS - males or females?

Answer 3

Females 2:1 Males

Oestrogen-driven disease

Question 4

The aetiology of IBS is unclear, but what is the most common proposed mechanism seen in 2/3 of patients?

Answer 4

Visceral hypersensitivity

Question 5

List some symptoms of IBS

Answer 5

Bloating
Abdo pain/discomfort
Increased frequency of toilet visits
Mucus stool
Incomplete emptying

Question 6

What are the most common trigger factors of IBS?

Answer 6

Diet (bread, low-fibre)
Infection
Menstruation
Drugs (opiates e.g. codeine)
Psychological factors

Question 7

What are some alarm features of IBS symptoms that warrant deeper investigation?

Answer 7

Age > 50
More recent onset
Woken up from sleep needing toilet
Rectal bleeding
Weight loss
Anaemia
Family history of CRC

Question 8

List some general investigations done for IBS

Answer 8

FBC
CRP
Antibody test for coeliac disease
Lower GI test if age > 50

Question 9

What is the initial, and often most effective, management of IBS?

Answer 9

Improve diet - reduce fibre and meal times

Stop opiates and analgesia

Question 10

Name an anti-spasmodic drug that could be used for IBS

Answer 10

Mebeverine

Hyoscine

Question 11

Name an anti-diarrhoeal agent

Answer 11

Loperamide

Question 12

Name an anti-depressant agent that may be used for IBS

Answer 12

Amitryptiline