Irritable Bowel Syndrome

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Irritable Bowel Syndrome

• Dr Jennifer Anthony
• GP Registrar
• March 2008

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What is IBS?

• Chronic, relapsing often lifelong
• Unknown aetiology, multifactorial
• Prevalence of 10-20
• Age 20-30
• Femalemale 21
• New NICE guideline Feb 2008

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Initial assessment

• Positive diagnosis
• 6 months of
• Abdominal pain or discomfort
• Relieved by defaecation
• Bloating
• More common in women
• Change in bowel habit
• Straining, urgency, incomplete evacuation
• Passage of mucus
• Other features e.g. lethargy, backache, nausea

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Red flags

• Refer to secondary care
• unintentional and unexplained weight loss
• rectal bleeding
• a family history of bowel or ovarian cancer
• a change in bowel habit to looser /or more
  frequent stools persisting gt 6 weeks in a person
  gt60 years
• anaemia
• abdominal/ rectal masses
• raised inflammatory markers

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Investigations

• NICE guideline recommends
• FBC
• Plasma viscosity
• CRP
• Tissue transglutaminase

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Not recommended

• USS
• Sigmoidoscopy
• Colonoscopy
• Ba enema
• TFTs
• Microscopy and culture faecal ova and parasite
• FOB

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Management diet and lifestyle

• Regular meals, take time to eat
• Drink plenty of fluid
• Restrict tea and coffee to three cups per day
• Reduce alcohol and fizzy drinks
• Limit intake of high-fibre food
• Reduce intake of resistant starch

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Diet and lifestyle cont.

• Limit fresh fruit to 3 portions per day
• For diarrhoea, avoid sorbitol, an artificial
  sweetener found in sugar-free sweets and drinks
• For wind and bloating consider increasing intake
  of oats and linseeds
• Increase exercise
• Maximise relaxation time

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Management pharmacological therapy

• Avoid aloe vera
• Probiotics, trial for 4 weeks
• Antispasmodics
• Laxatives, but avoid lactulose
• Loperamide 1st choice antimotility drug
• Adjust above according to stool consistency

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Management 2nd line

• Low dose TCA
• SSRI
• No effect after 12 months
• Psychological therapies e.g. CBT, hypnotherapy
• Avoid reflexology and acupuncture
• Annual review

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Conclusion

• A positive diagnosis, ABC
• Red flags
• Basic investigations
• Lifestyle
• Pharmacotherapy
• Annual review

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