Irritable Bowel Syndrome
Definition
altered bowel habits + abdominal Sx with no organic cause, ie. dx of exclusion, due to intestinal dismotility or increased visceral perception
Epidemiology:
10-20%, <40yo, F>M
Clinical Features
Symptoms
chronic abdo pain/ discomfort that is relived by defecation, worsens after food and exacerbated by stress, menses, or gastroenteritis; altered bowel habits that may alternate, pasty/ribbony/ pencil-thin stools, urgency, incomplete evacuation, bloating/distension, mucous PR, nausea, urinary frequency, vague back pain, heartburn
Signs
?distension, generalised abdo tenderness, otherwise usually normal
Investigations
Bloods (FBE, ESR, CRP, LFT, coeliac serology) - usually sufficient if presentation is classical
Others: colonoscopy, gastroscopy, Ca-125, stool culture etc if indicated
Management
Colic/ bloating - anti spasmodics
Chronic pain +/- depression - CBT, TCA, amitriptyline
Source
OHCM 9th Ed 2014
Harrison's 18th Ed 2012
altered bowel habits + abdominal Sx with no organic cause, ie. dx of exclusion, due to intestinal dismotility or increased visceral perception
Epidemiology:
10-20%, <40yo, F>M
Clinical Features
Symptoms
chronic abdo pain/ discomfort that is relived by defecation, worsens after food and exacerbated by stress, menses, or gastroenteritis; altered bowel habits that may alternate, pasty/ribbony/ pencil-thin stools, urgency, incomplete evacuation, bloating/distension, mucous PR, nausea, urinary frequency, vague back pain, heartburn
Signs
?distension, generalised abdo tenderness, otherwise usually normal
Investigations
Bloods (FBE, ESR, CRP, LFT, coeliac serology) - usually sufficient if presentation is classical
Others: colonoscopy, gastroscopy, Ca-125, stool culture etc if indicated
Management
- Rx prognosis only about 50% aim to alleviate/ take edge off Sx
- Refer if unsure of dx
- Healthy diet, but avoid foods that may worsen Sx (fiber, lactose, wheat, starch, caffeine, sorbitol, ETOH, fizzy drinks)
- Lifestyle - keep fit, fluids; increase in fiber may worsen Sx, so avoid insoluble fiber such as bran (oats are better)
- Rx - Biscodyl (stimulant), sodium picosulphate (osmotic), psyllium (bulking). Avoid lactulose (osmotic) as it ferments —> more gas and bloating
Colic/ bloating - anti spasmodics
Chronic pain +/- depression - CBT, TCA, amitriptyline
Source
OHCM 9th Ed 2014
Harrison's 18th Ed 2012