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Irritable Bowel Syndrome

Irritable Bowel Syndrome is when there's abdominal symptoms w/o an organic cause. It's more common in younger women.

“Depiction of a person suffering from Irritable Bowel Syndrome (IBS)” © https://www.myupchar.com/en (Licensed under CC-BY 4.0) https://creativecommons.org/licenses/by/4.0/


Diagnostic criteria:

  • Abdominal pain/discomfort that is either relieved by defecation OR associated with altered bowel habits, PLUS 2+ of:

    • Bloating

    • Symptoms made worse by eating

    • Altered stool passage (e.g. straining, urgency, incomplete emptying)

    • PR mucous


Symptoms that would point towards other organic diseases are PR bleeding, weight loss, fever.


Differentials - IBD, Coeliac disease, Cancer


Investigations - Aim is to rule out other organic differentials:

  • Faecal Calprotectin, FBC, CRP/ESR - rule out IBD

  • Anti-TTG, anti-Endomysial - rule out Coeliac disease


Management

Important to reassure the patient that it isn’t a serious pathology.


Conservative - Stay hydrated, Regular, small meals, Less alcohol and caffeine, Change diet (refer to dietician)


Medical:

  • 1st line - Loperamide, Laxatives, Antispasmodics (e.g. mebeverine hydrochloride, buscopan)

  • 2nd line - Amitriptyline

  • 3rd line - SSRIs



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