Gastrointestinal System >
Irritable Bowel Syndrome (IBS)

“A functional disorder characterised by abdominal pain associated with bowel dysfunction”

Risk Factors
  • Early life trauma
  • Emotional stress
  • <50 y/o
  • Female sex
  • Previous enteric infection
Aetiology

No specific cause but associated with dysbiosis in the gut

Pathophysiology

Altered gut reactivity (motility and secretion) in response to various stimuli (personal stress, certain foods, bacterial overgrowth, gut distension and inflammation) → pain and constipation/ diarrhoea

Clinical Presentation
  • Abdominal discomfort (lower/mid-abdomen) relieved on the passage of stool
  • Alteration of bowel habits (constipation, diarrhoea or both)
  • Abdominal bloating
  • Mucus covering stool
Investigations
  • Diagnosis of exclusion (Ix should all be negative):
    • FBC
    • Stool studies
    • Anti-endomysial antibodies
    • Anti-tTG antibodies
    • Plain abdominal x-ray
    • Flexible sigmoidoscopy
    • Colonoscopy
Management
  • Dietary and lifestyle modifications:
    • Reduced FODMAPs
    • Reduced stress
    • Physiotherapy
    • Probiotics
    • Food diary
    • Reduced caffeine and alcohol
    • Exercise
  • Antispasmodics – dicycloverine, peppermint oil
  • CBT/hypnotherapy
  • IBS-C: laxatives (ispaghula, lactulose), SSRI (citalopram)
  • IBS-D: antidiarrheals (loperamide, cholestyramine), TCAs (amitriptyline
Complications
  • Impact on quality of life
  • Haemorrhoids (a result of straining)
  • Malnutrition (strict diets)

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