476374
Irritable Bowel Syndrome
- Symptoms & Signs
- Symptoms: Central/lower abdo pain relieved by
defecation, abdo bloating, altered bowel habit
(constipation & diarrhoea), tenesmus, mucus PR.
Symptoms are chronic (>6months), exacerbated by
stress, menstruation, gastroenteritis. Signs:
Examination often normal, may see generalised abdo
tenderness, insufflations of air during sigmoidoscopy
may reproduce pain.
- Markers suggesting other disease
- Age >40yrs, hx <6months, anorexia, weight loss, waking at night with
pain/diarrhoea, mouth ulcers, abnormal investigations (ie raised CRP,
reduced Hb). PR bleeding - investigate urgently.
- Age >40yrs, hx <6months, anorexia, weight loss, waking at night with
pain/diarrhoea, mouth ulcers, abnormal investigations (ie raised CRP,
reduced Hb). PR bleeding - investigate urgently.
- Symptoms: Central/lower abdo pain relieved by
defecation, abdo bloating, altered bowel habit
(constipation & diarrhoea), tenesmus, mucus PR.
Symptoms are chronic (>6months), exacerbated by
stress, menstruation, gastroenteritis. Signs:
Examination often normal, may see generalised abdo
tenderness, insufflations of air during sigmoidoscopy
may reproduce pain.
- Investigations
- Young with classic hx
- FBC, ESR, LFT, celiac
serology, urinalysis +/-
sigmoidoscopy with rectal
biopsy
- FBC, ESR, LFT, celiac
serology, urinalysis +/-
sigmoidoscopy with rectal
biopsy
- >45yrs/any marker of
organic disease
- colonoscopy and if
unavailable then barium
enema
- colonoscopy and if
unavailable then barium
enema
- Prominent diarrhoea
- LFT, stool culture, B12/folate, anti-endomysial
antibodies, TSH, consider referral +/- barium
follow-through +/- rectal biopsy (if symptoms
suggest small bowel dis).
- LFT, stool culture, B12/folate, anti-endomysial
antibodies, TSH, consider referral +/- barium
follow-through +/- rectal biopsy (if symptoms
suggest small bowel dis).
- Further investigations, guided by symptoms
- Dyspepsia/reflux = upper GI endoscopy. Coeliac
suspected and anti-endomysial antibodies +ve =
duodenal biopsy. Potential infection = giardia tests.
Crohn’s suspected = small bowel radiology. Chronic
pancreatitis suspected = ERCP. Active pancreatitis
suspected = MRCP
- Dyspepsia/reflux = upper GI endoscopy. Coeliac
suspected and anti-endomysial antibodies +ve =
duodenal biopsy. Potential infection = giardia tests.
Crohn’s suspected = small bowel radiology. Chronic
pancreatitis suspected = ERCP. Active pancreatitis
suspected = MRCP
- Refer
- If either: equivocal diagnosis, changing symptoms in known
IBS, refer to surgeon if rectal mucosal prolapse, refer to
dietician if food intolerance, refer to psychiatrist if pronounced
stress/depression, refer to gynaecologist if cyclical pain/difficult
pelvic infection
- If either: equivocal diagnosis, changing symptoms in known
IBS, refer to surgeon if rectal mucosal prolapse, refer to
dietician if food intolerance, refer to psychiatrist if pronounced
stress/depression, refer to gynaecologist if cyclical pain/difficult
pelvic infection
- Young with classic hx
- Treatment
- Rarely 100% successful. Food intolerance: Exclusion diets.
Constipation: increase fibre intake gradually; fibogel
(ispaghula) or celevac (methylcellulose) 3-6 tablets BD with
>300ml fluid. Diarrhoea: bulking agent +/- loperamide after
each loose stool. Colic and bloating: Antispasmodics may
help ie mebeverine. Dyspepsia: metoclopramide or antacids.
Psychological therapy: emphasis 50% symptoms improve/go
within 1yr. Low dose amitriptyline/psychotherapy/CBT may
help.
- Rarely 100% successful. Food intolerance: Exclusion diets.
Constipation: increase fibre intake gradually; fibogel
(ispaghula) or celevac (methylcellulose) 3-6 tablets BD with
>300ml fluid. Diarrhoea: bulking agent +/- loperamide after
each loose stool. Colic and bloating: Antispasmodics may
help ie mebeverine. Dyspepsia: metoclopramide or antacids.
Psychological therapy: emphasis 50% symptoms improve/go
within 1yr. Low dose amitriptyline/psychotherapy/CBT may
help.
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