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IBS

IBS. VTS teaching 1/2/12 Leena Patel. Overview. Statistics Pathophysiology Symptoms Red flags Diagnosis Investigation Management. Statistics. Prevalence Europe – 11.5% America – 10-15% Female: Male ratio of 2:1 Can affect any age group but commonly young people

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IBS

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  1. IBS VTS teaching 1/2/12 Leena Patel

  2. Overview • Statistics • Pathophysiology • Symptoms • Red flags • Diagnosis • Investigation • Management

  3. Statistics • Prevalence Europe – 11.5% America – 10-15% • Female: Male ratio of 2:1 • Can affect any age group but commonly young people • Only 15% seek help! • Make up upto 30% of secondary care referrals

  4. Pathophysiology • Gastrointestinal motility • Visceral hypersensitivity • Intestinal inflammation • Post-infectious • Food sensitivities • Bacterial overgrowth • Psychosocial dysfunction

  5. ABC • NICE suggests consider diagnosis of IBS if presents with: Abdominal pain/discomfort Bloating Change in bowel habit

  6. Symptoms- Gastrointestinal • Abdominal pain/discomfort • Bloating/distension • Increased flatulence/belching • Change in bowel habit – diarrhoea, constipation, alternating diarrhoea & constipation • Change in stool passage - urgency, occasional incontinence, straining, incomplete bowel emptying • Mucus in stool • Nausea

  7. Extra-gastrointestinal symptoms • Lethargy • Back/ thigh pain • Urinary frequency and urgency • Mennorhagia • Dysmenorrhoea • Dyspareunia • Headache • Low mood • Fibromyalgia symptoms

  8. Red flags • Rectal bleeding • Unintentional or unexplained weight loss • Anorexia/malnutrition • >60 years old with >6weeks of change in bowel habit to loose stool/increased frequency • FH of bowel/ovarian cancer • Anaemia • Abdominal/rectal mass • Pain affecting sleep • Progressive and worsening • Raised inflammatory markers

  9. Diagnostic criteria • Abdominal pain/discomfort that is • Relieved by defecation OR • Associated with altered bowel frequency/stool form AND at least 2 of the following:- • Altered stool passage (straining, urgency, incomplete evacuation) • Abdominal bloating, distension, tension, hardness • Symptoms made worse by eating • Passage of mucus

  10. investigations DO’S • FBC • ESR or CRP • Coeliac serology (TTG/EMA) • May consider stool culture (giardia) Don'ts • Ultrasound • TSH • H2 breath test for H-pylori/lactose intolerance • Barium enema/endoscopic investigations

  11. management • Diet and lifestyle changes • Medication • Psychological therapies

  12. Diet & lifestyle • Regular meals • Avoid missing/delaying meals • 8 glasses of fluid/day • Minimize caffeine to <3 cups/day • Reduce alcohol and fizzy drinks • Increase physical activity • Limit fresh fruit to 3 portions/day • Can try probiotics or 4 weeks, discontinue if not effective

  13. Diet • Limit amounts of high fibre foods (e.g. Bran) • Reduce intake of resistant starch (e.g. Grains, seeds, tubers, reheated potatoes) • Reduce gas producing foods (e.g. Onion, bananas, celery, carrots) • For wind/bloating – increase soluble fibre (e.g. Oats, isphagula) and linseeds (1 tbsp/day) • For diarrhoea, try limiting artificial sweetener use and sorbitol • If particular foods thought to be associated, can try one exclusion at a time for a period of 4 weeks • Dietitian referral if appropriate

  14. drugs • ANTISPASMODICS • Anticholinergic e.g. hyoscine • Smooth muscle relaxants e.g. Mebeverine, peppermint oil Good for symptoms of bloating, wind and pain Try different ones, combination of both sometimes beneficial Tachyphylaxis can occur, prn use to reduce this

  15. Drugs • LAXATIVES Avoid lactulose as causes bloating and wind Regular use recommended rather than intermittent use • ANTIDIARRHOEALS Can titrate dose up and down to control motions, also increases anal tonewhich will help reduceincontinence

  16. Drugs • ANTIDEPRESSANTS • Tricyclic antidepressants (e.g.. Amitriptyline) - low dose usually sufficient - Can cause constipation so may be help if diarrhoea predominant IBS • SSRI

  17. Drugs • Possible treatment options (some evidence, ongoing research) • Antibiotics • 5-HT3 antagonists (e.g.. ondansetron) • 5-HT4 agonists

  18. Psychological therapies • CBT (individual or group CBT) • Hypnotherapy Combination of antidepressant and psychological therapies found to more effective.

  19. Summary • Think about IBS if present with ABC • Ask about GI and non-GI symptoms • Exclude red flags • Tests to exclude other possible diagnosis • Diet and lifestyle changes • Medication choices depending on predominant symptoms, trial for at least 4-6 weeks. • Psychological therapies shown to work but ?available locally

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