Irritable Bowel Syndrome Overview
66 Questions
0 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which of the following factors are associated with the aetiology of IBS? (Select all that apply)

  • Motility (correct)
  • Visceral hypersensitivity (correct)
  • Environmental factors
  • Genetic factors (correct)

    • Which of the following is NOT a common symptom of IBS?

  • Bloating
  • Diarrhea
  • Abdominal pain
  • Rectal bleeding (correct)

    • IBS can be diagnosed through specific laboratory tests.

    False

    Match the following types of management for IBS with their categories:

    <p>Dietary modifications = Non-pharmacological Anti-spasmodics = Pharmacological Cognitive behavioural therapy = Non-pharmacological Loperamide = Pharmacological</p> Signup and view all the answers

    Which medication is recommended for constipation predominant IBS (IBS-C)?

    <p>Lactulose</p> Signup and view all the answers

    Which of the following is a common trigger for IBS symptoms?

    <p>High FODMAP foods</p> Signup and view all the answers

    In which type of IBS would you expect to see increased frequency of bowel movements?

    <p>IBS-D</p> Signup and view all the answers

    What symptom is commonly associated with IBS?

    <p>Chronic recurrent abdominal pain</p> Signup and view all the answers

    What psychological factor is associated with triggering IBS symptoms?

    <p>Stress and emotional tension</p> Signup and view all the answers

    What alteration in microbiome is often associated with IBS?

    <p>Imbalance and reduced diversity in gut flora</p> Signup and view all the answers

    In patients with diarrhoea-predominant IBS, what is often found regarding bacterial presence?

    <p>Increased types and numbers of bacteria</p> Signup and view all the answers

    What is the preferred opioid for pain control in IBS-D due to its less constipating effect?

    <p>Eluxadoline</p> Signup and view all the answers

    Which of the following medications is most suitable to alleviate constipation symptoms in patients with IBS?

    <p>Lactulose</p> Signup and view all the answers

    Which type of medication is typically the first consideration for managing the pain associated with IBS?

    <p>Antidepressants</p> Signup and view all the answers

    What should be the primary focus when initiating treatment for a patient with recurrent abdominal pain and constipation related to IBS?

    <p>Symptom relief and management</p> Signup and view all the answers

    Which adverse effect is associated with opioids that makes eluxadoline a preferred choice in managing IBS-D?

    <p>Constipation</p> Signup and view all the answers

    Which statement accurately describes irritable bowel syndrome (IBS)?

    <p>It is characterized by recurrent abdominal pain and altered bowel habits.</p> Signup and view all the answers

    Which of the following factors is NOT considered a possible contributor to the aetiology of IBS?

    <p>Presence of structural abnormalities</p> Signup and view all the answers

    How do motor abnormalities contribute to IBS?

    <p>They lead to prolonged transit time in constipation-predominant IBS.</p> Signup and view all the answers

    Which component has been associated with inflammation in some IBS patients?

    <p>Increased gut wall T-lymphocytes and mast cells</p> Signup and view all the answers

    What symptom is often reported to relieve abdominal pain in IBS patients?

    <p>Defecation</p> Signup and view all the answers

    Which of the following best outlines the nature of IBS as a medical condition?

    <p>It is primarily a functional disorder without clear organic causes.</p> Signup and view all the answers

    In the context of IBS, what does visceral hypersensitivity typically refer to?

    <p>Increased awareness of gut sensations such as pain and bloating</p> Signup and view all the answers

    What is one of the main challenges regarding the diagnosis of IBS?

    <p>No specific laboratory tests can confirm its presence.</p> Signup and view all the answers

    Which symptom is commonly associated with coeliac disease?

    <p>Abdominal bloating</p> Signup and view all the answers

    What is the primary characteristic of irritable bowel syndrome (IBS)?

    <p>Chronic abdominal pain with altered bowel habits</p> Signup and view all the answers

    What does the presence of elevated WBC suggest in the context of a blood test for IBS?

    <p>Inflammatory bowel disease</p> Signup and view all the answers

    Which treatment approach is primarily recommended for managing IBS symptoms?

    <p>Dietary and lifestyle changes along with pharmacological management</p> Signup and view all the answers

    Which test is most useful for assessing the presence of inflammatory bowel disease in stool analysis?

    <p>Faecal lactoferrin</p> Signup and view all the answers

    What are the common side effects associated with the use of amitriptyline in IBS treatment?

    <p>Dry mouth and sedation</p> Signup and view all the answers

    Which of the following is NOT a recommended dietary modification for IBS management?

    <p>Increased protein intake</p> Signup and view all the answers

    Which laxative is designed to be used with a stool softener for IBS management?

    <p>Sennakot</p> Signup and view all the answers

    What is included in the symptom-based diagnostic criteria for IBS?

    <p>Bloating and abdominal distention</p> Signup and view all the answers

    What is a major symptom differentiating macrogol from lactulose in IBS treatment?

    <p>Less flatulence and abdominal cramping</p> Signup and view all the answers

    Which of the following findings would suggest an alternative diagnosis rather than IBS?

    <p>Positive faecal occult blood test</p> Signup and view all the answers

    What is the first-line non-pharmacological management strategy for IBS?

    <p>Reassurance</p> Signup and view all the answers

    What findings in imaging may indicate complications of Crohn's disease?

    <p>Abscess and strictures visible on CT</p> Signup and view all the answers

    Which symptom is least likely associated with IBS?

    <p>Rectal bleeding</p> Signup and view all the answers

    What psychological condition is significantly correlated with increased IBS symptoms?

    <p>Post-traumatic stress disorder</p> Signup and view all the answers

    Which of the following findings would most strongly indicate IBS over other gastrointestinal disorders?

    <p>Normal abdominal examination</p> Signup and view all the answers

    Which factor is least likely to contribute to the pathophysiology of IBS?

    <p>Increased physical activity</p> Signup and view all the answers

    Which medication is least likely to be effective for managing constipation in a patient with IBS?

    <p>Amitriptyline</p> Signup and view all the answers

    In a patient with IBS-D, which of the following medications is specifically preferred due to its reduced constipating effects?

    <p>Eluxadoline</p> Signup and view all the answers

    Which of the following laxatives would typically be recommended before initiating a pharmacological treatment for constipation in IBS patients?

    <p>Macrogol</p> Signup and view all the answers

    Which adverse effect should be closely monitored when prescribing opioids for pain management in IBS patients?

    <p>Constipation</p> Signup and view all the answers

    What is a common psychological factor that may exacerbate symptoms in IBS patients, according to current understanding?

    <p>Heightened stress levels</p> Signup and view all the answers

    What is a significant disadvantage of using amitriptyline as a first choice agent for IBS management?

    <p>It has significant side effects.</p> Signup and view all the answers

    Which laxative is known for causing less flatulence and cramping than lactulose?

    <p>Polyethylene glycol</p> Signup and view all the answers

    Which symptom, when present, may suggest an alternative diagnosis rather than irritable bowel syndrome?

    <p>Nocturnal diarrhoea</p> Signup and view all the answers

    What does elevated white blood cell count in blood tests suggest when investigating IBS?

    <p>Inflammatory bowel disease or an infectious aetiology</p> Signup and view all the answers

    What characterizes irritable bowel syndrome (IBS) in clinical diagnosis?

    <p>Chronic abdominal pain without an identifiable organic cause.</p> Signup and view all the answers

    In the treatment of IBS, why might stimulant laxatives such as sennakot not be sufficient on their own?

    <p>They should always be used with a stool softener.</p> Signup and view all the answers

    Which of the following tests is specifically useful for assessing the presence of coeliac disease?

    <p>Serology testing for anti-tissue transglutaminase antibodies</p> Signup and view all the answers

    Which statement best reflects the diagnostic approach for IBS?

    <p>It relies on clinical diagnosis with investigations to exclude other conditions.</p> Signup and view all the answers

    In stool analysis for IBS, which finding indicates a potential inflammatory bowel disease?

    <p>Faecal lactoferrin</p> Signup and view all the answers

    What dietary modification is specifically recommended for managing symptoms of irritable bowel syndrome?

    <p>Avoidance of high FODMAP foods</p> Signup and view all the answers

    Which imaging study is indicated to assess for complications related to Crohn's disease?

    <p>CT abdomen/pelvis</p> Signup and view all the answers

    What condition is characterized by symptoms such as abdominal bloating, pain, and diarrhea upon gluten consumption?

    <p>Coeliac disease</p> Signup and view all the answers

    How might the findings of faecal occult blood in stool tests be interpreted?

    <p>Suggests a possibility of colorectal cancer or inflammatory bowel disease</p> Signup and view all the answers

    In management of IBS-D, which of the following medications is indicated only after ruling out an infectious cause?

    <p>Loperamide</p> Signup and view all the answers

    What distinguishes macrogol from other osmotic laxatives like lactulose in terms of gastrointestinal side effects?

    <p>Macrogol does not typically cause cramping or increased flatulence</p> Signup and view all the answers

    Which method of increasing gastrointestinal fluid secretion does linaclotide employ?

    <p>Stimulates the secretion of chloride and bicarbonate into the intestines</p> Signup and view all the answers

    Which psychological treatment option has been shown to aid in IBS symptom management?

    <p>Cognitive behavioural therapy</p> Signup and view all the answers

    How do bile acid sequestrants like cholestyramine function in the management of IBS-D?

    <p>They bind bile acids, reducing diarrhea frequency</p> Signup and view all the answers

    What is a common adverse effect associated with the use of TCAs like amitriptyline in IBS treatment?

    <p>Constipation and sedation</p> Signup and view all the answers

    What role do probiotics serve in the management of IBS?

    <p>They may improve symptoms in some patients but are not routinely recommended</p> Signup and view all the answers

    Study Notes

    Irritable Bowel Syndrome (IBS)

    • IBS is a chronic gastrointestinal disorder marked by recurring abdominal pain and altered bowel habits.
    • This functional condition, affecting approximately 15% of adults, is the leading cause of gastroenterology referrals.

    Aetiology

    • The cause of IBS remains unclear, but it is believed to be multifactorial.
    • Factors like motility, visceral hypersensitivity, inflammatory processes, genetics, immune response, psychological influences, and dietary components are implicated.

    Pathophysiology

    • Inflammatory or Immune Involvment:
      • IBS can sometimes occur alongside inflammatory bowel disease and might develop after bacterial or parasitic gastroenteritis.
      • Increased gut wall T-lymphocytes, mast cells, and plasma pro-inflammatory cytokines are observed in some IBS patients.
    • Motility:
      • Motor abnormalities, such as increased frequency and irregularity of bowel contractions and prolonged transit time, are present in constipation-predominant IBS.
    • Visceral Hypersensitivity:
      • IBS patients exhibit heightened sensitivity to normal gut wall receptor stimulation, leading to increased pain and bloating in response to bowel distension.
    • Alteration in Intestinal Microflora:
      • IBS is associated with an imbalance and reduced diversity in the intestinal microbiome, likely due to the interaction of microflora with specific foods, especially carbohydrates, and their influence on epithelial barrier integrity and enteroendocrine signaling.
    • Bacterial Overgrowth:
      • Increased numbers or types of bacteria are observed in some IBS patients, particularly diarrhoea-predominant IBS.
    • Genetic:
      • Familial studies and investigation of specific gene polymorphisms, like the serotonin transporter gene, indicate a genetic predisposition in some IBS patients.
    • Psychological Stress or Abuse
      • IBS episodes are often triggered by stress and heightened emotional tension.
      • Increased likelihood of IBS is observed in individuals with a history of physical or sexual abuse, and PTSD.

    Clinical Manifestations

    • Symptoms: Chronic, recurrent abdominal pain (typically in the lower or mid-abdomen), constipation, diarrhoea, bloating, abdominal distension, and urgency of defaecation.
    • Signs: Rarely mucus in stools. Typically, a normal abdominal examination (with potential mild lower abdominal tenderness).

    Differential Diagnosis:

    • Crohn's Disease: Abdominal cramps, diarrhoea, rectal bleeding, weight loss, fevers, fatigue, possible mass in the right lower quadrant on abdominal exam, oral ulcers.
    • Ulcerative Colitis: Bloody diarrhoea, abdominal pain, urgency, extra-intestinal manifestations like arthropathy, erythema nodosum, etc.
    • Coeliac Disease: Abdominal bloating, pain and diarrhoea triggered by gluten consumption, unintentional weight loss, and early osteoporosis due to malabsorption.
    • Colorectal Cancer (CRC): Unintentional weight loss, altered bowel habit, melena, hematochezia, nocturnal diarrhoea
    • Infectious Gastroenteritis (Parasitic or Bacterial)

    Diagnosis

    • The presence of chronic abdominal pain and altered bowel habits, along with bloating, abdominal distention, and urgency, should raise suspicion of IBS.
    • IBS is primarily a clinical diagnosis, relying on the fulfilment of symptom-based diagnostic criteria and the exclusion of underlying organic disease.

    Investigations

    • These are employed to rule out alternative diagnoses based on symptoms and risk factors:
      • Blood Tests:
        • FBC: Should be normal in IBS; anaemia (CRC or malabsorption syndrome) or elevated White Blood Cell count (inflammatory bowel disease; IBD) suggests a different cause.
        • ESR/CRP: Should be normal. Elevated values could indicate IBD or an infectious cause.
        • Serology testing for coeliac disease: Positive anti-tissue transglutaminase or IgA endomysial antibodies.
      • Stool Tests:
        • Faecal occult blood: May be positive in CRC or IBD.
        • Faecal calprotectin/faecal lactoferrin: Elevated in IBD; calprotectin offers superior clinical utility.
        • Stool test for bacteria and parasites.
      • Imaging:
        • PFA (Plain film abdominal x-ray): Distended bowel loops in obstruction.
        • CT abdomen/pelvis: May reveal complications of Crohn's (abscess, strictures, adhesions, etc.) or CRC.
      • Others:
        • OGD/colonoscopy: Indicated if IBD/Coeliac/CRC is suspected.

    Management

    • Non-Pharmacological (1st Line):

      • Reassurance
      • Dietary modifications:
        • Avoidance of high FODMAP foods (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols)
        • Avoidance of gas-producing foods.
        • Insoluble fibre avoidance (e.g., bran)
        • Gluten avoidance
        • Lactose avoidance
      • Additional:
        • Cognitive behavioural therapy
        • Hypnotherapy
        • Acupuncture
        • Yoga

    • Pharmacological:

      • Abdominal pain and bloating:

        • Anti-spasmodics: Mebeverine, dicyclomine, peppermint oil
        • Antidepressants: TCAs (e.g., amitriptyline, nortriptyline) (IBS-D). Significant side effects, not first-line.
        • Antibiotics: Rifaximin
        • Probiotics: Not routinely recommended but associated with improved symptoms in some patients.

      • Constipation (IBS-C):

        • Soluble fibre: e.g., psyllium/ispaghula
        • Osmotic laxatives:
          • Lactulose:
            • MOA: Non-absorbable synthetic sugar. Colonic metabolism of sugars leads to a laxative effect by increasing intraluminal gas formation and osmolality, reducing transit time. Increased ammonia uptake by colonic bacteria utilizing the trapped colonic ammonia as a nitrogen source for protein synthesis. Role in hepatic encephalopathy by reducing ammonia.
            • Side effects: Flatulence, abdominal pain, diarrhoea, nausea, and vomiting.
          • Macrogol: Polyethylene glycol (PEG). Forms hydrogen bonds with water molecules preventing their absorption, leading to more water in stool, facilitating passage. Associated with less flatulence and cramping compared to other osmotic laxatives.
        • Stimulant laxatives: e.g., Sennakot, Bisacodyl.
          • Irritate luminal nerves, stimulating colonic motility. Stimulates stool movement but doesn't soften it as effectively as osmotics. Recommended as an adjunct to stool softeners.
          • Caution: Potential for bowel perforation in intestinal obstruction.
        • Secretagogues: Lubiprostone, linaclothide, plecanatide, or tenapanor. Increase fluid secretion and movement in the GIT.

      • Diarrhoea (IBS-D):

        • Anti-diarrheal: Loperamide (only after ruling out infectious causes).
        • Bile acid sequestrants: Cholestyramine
        • Opioid agonists/antagonists: E.g., eluxadoline (preferred opioid for pain control in IBS-D as it has less constipating adverse effects)

    Key Points

    • IBS is the most frequent reason for gastroenterology referrals.
    • It is characterized by chronic abdominal pain with disordered bowel function, without underlying organic causes.
    • Its aetiology remains unclear.
    • Diagnosis is primarily clinical, supported by investigations to exclude alternative diagnoses, if clinically indicated.
    • Treatment is multimodal, with dietary and lifestyle changes, and symptomatic pharmacological management being central.

    Irritable Bowel Syndrome (IBS)

    • A chronic gastrointestinal disorder characterized by recurrent abdominal pain, altered bowel habits, bloating, and pain relief with defecation.
    • It is a functional condition, meaning there's no identifiable organic or structural abnormality causing the symptoms.
    • Approximately 15% of the adult population experience IBS, making it the most common reason for gastroenterology referrals.

    Causes of IBS

    • The exact cause of IBS is unclear, but it is believed to be multifactorial.
    • Contributing factors include:
      • Motility: Abnormal bowel contractions, increased frequency, irregularity, and potential for prolonged transit time in constipation-predominant IBS.
      • Visceral Hypersensitivity: Heightened sensitivity to normal gut wall stimulation, resulting in increased awareness of pain and bloating in response to bowel distension.
      • Inflammatory/Immune Involvement: May occur alongside inflammatory bowel disease or following bacterial or parasitic gastroenteritis, suggesting a role for inflammation or immune response. Elevated T-lymphocytes, mast cells, and pro-inflammatory cytokines are observed in some IBS patients.
      • Alteration in Intestinal Microflora: Imbalance and reduced diversity in the intestinal microbiome, potentially due to the interaction of microflora with specific foods (particularly carbohydrates) and their influence on epithelial barrier integrity and enteroendocrine signaling.
      • Bacterial Overgrowth: Increased numbers or types of bacteria, particularly in diarrhoea-predominant IBS.
      • Genetic Susceptibility: Familial studies and gene polymorphisms (e.g., serotonin transporter gene) suggest a genetic predisposition in some cases.
      • Psychological Stress/Abuse: Bouts of IBS are frequently triggered by stress, emotional tension, and a history of physical or sexual abuse and PTSD.

    Symptoms and Signs

    • Common Symptoms:

      • Chronic, recurrent abdominal pain (typically lower or mid-abdomen, cramping)
      • Constipation
      • Diarrhoea
      • Bloating
      • Abdominal distension
      • Urgency of defaecation

    • Signs:

      • Rarely mucus in stools
      • Typically, a normal abdominal examination (may exhibit mild lower abdominal tenderness)

    • Note:* The absence of any red flag symptoms is crucial for diagnosing IBS.

    Differential Diagnosis

    • To rule out other potential causes, a differential diagnosis is essential.
    • Possible conditions to consider include:
      • Crohn's Disease: Abdominal cramps, diarrhoea, rectal bleeding, weight loss, fevers, fatigue, possible mass in the right lower quadrant (RLQ) on abdominal exam, oral ulcers.
      • Ulcerative Colitis: Bloody diarrhoea, abdominal pain, urgency, extra-intestinal manifestations (e.g., arthropathy, erythema nodosum).
      • Coeliac Disease: Abdominal bloating, pain, and diarrhoea triggered by gluten consumption, unintentional weight loss, and early osteoporosis due to malabsorption.
      • Colorectal Cancer (CRC): Unintentional weight loss, altered bowel habit, melena, hematochezia, nocturnal diarrhoea.
      • Infectious Gastroenteritis (parasitic or bacterial)

    Diagnosis

    • IBS should be suspected in patients exhibiting characteristic symptoms, especially chronic abdominal pain and altered bowel habits (including bloating, abdominal distension, and urgency).
    • The diagnosis of IBS is primarily clinical, relying on the fulfillment of symptom-based diagnostic criteria and excluding other underlying organic diseases.
    • The presence of any warning signs may suggest an alternative diagnosis.

    Investigations

    • Investigations are primarily used to exclude other pathologies based on symptoms and risk factors, not to confirm IBS directly.
      • Blood Tests:
        • FBC (Full Blood Count): Should be normal in IBS; abnormalities like anaemia (CRC or malabsorption syndrome) or elevated white blood cells (WBC) (inflammatory bowel disease; IBD) suggest other causes.
        • ESR (Erythrocyte Sedimentation Rate)/CRP (C-Reactive Protein): Should be normal; elevated levels may indicate IBD or an infectious source.
        • Serology Testing for Coeliac Disease: Positive anti-tissue transglutaminase or IgA endomysial antibodies suggest coeliac disease.
      • Stool Tests:
        • Faecal Occult Blood: May be positive in CRC or IBD.
        • Faecal Calprotectin/Faecal Lactoferrin: Elevated in IBD; Calprotectin has higher clinical utility.
        • Stool Test for Bacteria and Parasites: To rule out infections.
      • Imaging:
        • PFA (Plain film Abdominal X-ray): Distended bowel loops might suggest bowel obstruction.
        • CT Abdomen/Pelvis: Can reveal complications of Crohn's (abscesses, strictures, adhesions) or identify CRC.
      • Others:
        • OGD (Oesophagogastroduodenoscopy)/Colonoscopy: Performed if IBD, coeliac disease, or CRC is suspected.
    • Histology:* Normal duodenal mucosa (left) vs. villous atrophy in coeliac disease (right)
    • Colonoscopy:* Skip lesions and ulceration in Crohn's.
    • PFA:* Dilated small bowel loops.

    ### Management

    • The primary approach involves non-pharmacological interventions.

    • First-Line Management:

      • Reassurance: Providing reassurance and education about IBS is crucial.
      • Dietary Modifications:
        • Avoidance of High FODMAP Foods: Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols, which are poorly absorbed and can worsen symptoms.
        • Avoidance of Gas-Producing Foods: Foods that cause gas may exacerbate symptoms.
        • Insoluble Fiber Avoidance: High intake of insoluble fiber may worsen constipation.
      • Lifestyle Changes:
        • Stress Management Techniques: Exercise, relaxation practices, and other stress reduction strategies are important.
        • Regular Sleep: Adequate sleep is vital for overall health and IBS symptom management.
        • Regular Bowel Habits: Establish a consistent routine for bowel movements.
        • Fluid Intake: Hydration is essential.
      • Pharmacological Management:
        • Antidiarrhoeals: Loperamide is commonly used to manage diarrhoea.
        • Antispasmodics: Hyoscine butylbromide (Buscopan) can help reduce abdominal pain and cramping.
        • Laxatives:
          • Macrogol: A bulk-forming laxative often preferred for constipation-predominant IBS as it tends to cause less flatulence and cramping compared to lactulose.
          • Lactulose: A synthetic sugar that draws water into the bowel, promoting bowel movements.
          • Sennakot: A stimulant laxative that should be used in conjunction with a stool softener.
        • Antidepressants:
          • Amitriptyline: A tricyclic antidepressant that can be helpful for pain relief, but is not a first-line option due to potential side effects.

    • Note: A multidisciplinary approach involving professionals such as gastroenterologists, psychologists, and dietitians is often recommended for comprehensive management of IBS.

    Key Points

    • IBS is the most frequent reason for gastroenterology referrals.
    • Characterized by chronic abdominal pain and altered bowel habits, but without an organic cause.
    • The precise cause of IBS remains undefined.
    • Diagnosis is predominantly clinical, supported by investigations to rule out other conditions if indicated.
    • Treatment is multifaceted, emphasizing dietary and lifestyle modifications alongside symptomatic pharmacological management..

    Resources

    • UpToDate - Pathophysiology of irritable bowel syndrome, Clinical manifestations and diagnosis of irritable bowel syndrome in adults, Treatment of irritable bowel syndrome in adults
    • BMJ Best Practice- Irritable Bowel Syndrome
    • https://www.ncbi.nlm.nih.gov/books/NBK536930/
    • https://pubmed.ncbi.nlm.nih.gov/30546252/

    Intestinal Microflora and IBS

    • IBS is linked to imbalanced and reduced intestinal microbiome diversity
    • Imbalance impacts food digestion, mainly carbohydrates
    • Plays a role in epithelial barrier integrity and enteroendocrine signalling

    Bacterial Overgrowth

    • IBS is associated with increased bacterial numbers and types
    • This is more prominent in diarrhea-predominant IBS

    Genetic Factors

    • Familial studies suggest genetic susceptibility to IBS
    • Specific genes like the serotonin transporter gene are implicated

    Psychological Factors

    • IBS episodes triggered by stress and emotional tension
    • Individuals with physical or sexual abuse history and PTSD have increased IBS risk

    Common IBS Symptoms and Signs

    • Chronic recurrent abdominal pain, typically lower or mid abdomen, cramping
    • Constipation
    • Diarrhea
    • Bloating
    • Abdominal distention
    • Urgency of defecation
    • Rarely mucus stools
    • Usually, a normal abdominal examination with potential mild abdominal tenderness

    IBS Differential Diagnoses

    • Crohn's Disease: Abdominal cramps, diarrhea, rectal bleeding, weight loss, fevers, fatigue, possible palpable RLQ mass, oral ulcers
    • Ulcerative Colitis: Bloody diarrhea, abdominal pain, urgency, extraintestinal manifestations like arthopathy and erythema nodosum
    • Celiac Disease: Abdominal bloating, pain, diarrhea triggered by gluten intake, unintentional weight loss, early osteoporosis due to malabsorption
    • Colorectal Cancer: Unintentional weight loss, altered bowel habit, melena, hematochezia, nocturnal diarrhea
    • Infectious Gastroenteritis: Parasitic or bacterial causes

    IBS Diagnosis

    • Suspect IBS in patients with chronic abdominal pain and altered bowel habit (bloating, distention, urgency)
    • Requires symptom-based diagnostic criteria fulfillment
    • Exclude underlying organic disease
    • Warning signs indicate potential alternative diagnoses

    IBS Investigations

    • Blood Tests: FBC, ESR/CRP, Serology testing for Celiac disease
    • Stool Tests: Faecal occult blood, Faecal calprotectin/faecal lactoferrin, Stool test for bacteria and parasites
    • Imaging: Plain film abdominal x-ray (PFA), CT abdomen/pelvis
    • Others: OGD/colonoscopy

    IBS Management

    • Non-Pharmacological First Line Management:
      • Reassurance
      • Dietary modifications: Avoidance of high FODMAP foods, gas-producing foods, insoluble fiber, gluten, lactose
      • Cognitive behavioral therapy, hypnotherapy, acupuncture, yoga

    FODMAP Foods

    • Fermentable Oligosaccharides (fructans, galactans), Disaccharides (lactose), Monosaccharides (fructose), Polyols (sugar alcohols)

    Pharmacological Management

    • Abdominal pain and bloating: Anti-spasmodics (mebeverine, dicyclomine, peppermint oil), Antidepressants (TCAs, amitriptyline, nortriptyline for IBS-D), Antibiotics (rifaximin), Probiotics
    • Constipation (IBS-C): Soluble fiber (psyllium/ispaghula), Osmotic laxatives (lactulose, macrogol), Stimulant laxatives (Sennakot, Bisacodyl), Secretagogues (lubiprostone, linaclotide, plecanatide, or tenapanor)
    • Diarrhea (IBS-D): Anti-diarrhoeal (loperamide), Bile acid sequestrants (cholestyramine), Opioid agonists/antagonists (eluxadoline)

    Key IBS Points

    • Most common reason for gastroenterology referral
    • Chronic abdominal pain and altered bowel habit without organic cause
    • Unknown etiology
    • Mainly a clinical diagnosis with investigations for differential exclusion
    • Multimodal treatment: Dietary and lifestyle changes, symptomatic pharmacotherapy
    • **

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    RCSI Irritable Bowel Syndrome Presentation PDF

    Description

    Explore the complexities of Irritable Bowel Syndrome (IBS), a chronic gastrointestinal disorder characterized by abdominal pain and altered bowel habits. This quiz covers the aetiology, pathophysiology, and the multifactorial aspects contributing to IBS, impacting millions worldwide. Gain insights into the condition's underlying mechanisms and its implications for affected individuals.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser