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Irritable Bowel Syndrome (IBS) (Main Causes (GI infection, Sexual,…
Irritable Bowel Syndrome (IBS)
Key Facts
Denotes a mixed group of abdominal symptoms for which no organic cause can be found
3 types
IBS-D - with diarrhoea
IBS-M - with constipation and diarrhoea
IBS-C - with constipation
Symptoms are exacerbated by stress, food, gastroenteritis or menstruation
Epidemiology
More common in FEMALES than males
Common, in western world around 1 in 5 report symptoms consistent with IBS
Age of onset is under 40
Main Causes
GI infection
Sexual, physical or verbal abuse
Psychological stress and trauma
Eating disorders
Depression, anxiety
Risk Factors
Previous severe and long diarrhoea
High hypochondriac anxiety and neurotic score at time of illness
Female
Pathophysiology
Dysfunction in the brain-gut axis results in disorder of intestinal motility and/or enhanced visceral perception (visceral hypersensitivity)
Clinical Presentation
Consider IBS if
There are 2 or more of:
Abdominal bloating/distension
Mucous in stool
Incomplete evacuation
Worsening symptoms after food
Urgency
Other symptoms; nausea, bladder symptoms and backache
Abdominal pain that is either relieved by defeacation or is associated with altered stool form or bowel frequency AND:
Symptoms are chronic (more than 6 months) and exacerbated by stress, menstruation or gastroenteritis (post-infection IBS)
If patient reports any of ABC
B - bloating
C - change in bowel habit
A - abdominal pain or discomfort
Multisystem disorder with many non-intestinal symptoms
Back pain
Joint hypermobility
Urinary infrequency, urgency, nocturia, and incomplete emptying of bladder
Fatigue
Painful period
General abdomen tenderness
Differential diagnosis
Lactose intolerance (especially in IBS-D)
Bile acid malabsorption
Coeliac disease (5% of IBS patients)
IBD
Colorectal cancer
Diagnosis
Faecal calprotectin - raised in IBD
Colonoscopy to rule out IBD or colorectal cancer
Bloods
ESR and CRP to look for inflammation
Coeliac serology - if a positive result then high chance being coeliac disease
FBC to look for anaemia
Rome III diagnostic criteria
Recurrent abdominal pain or discomfort at least 3 days a month in the past 3 months, associated with two or more of the following:
Onset associated with a change in frequency of stool
Onset associated with a change in form (appearance) of stool
Improvement with defecation
Since nothing physical to be found, diagnosis made by ruling out the differentials
Treatment
Dietary/lifestyle modification
Increase soluble fibre and decrease insoluble fibre
Pharmacological Management
For constipation
Laxative
For diarrhoea
Anti-motility agents
Pain/bloating
Antispasmodics
Still no better
Tricyclic antidepressants