IBS

Differential diagnosis

  • Malignancy (bowel, ovarian etc)
  • Thyroid disease
  • Coeliac disease
  • IBD

 

Data gathering

  • Red flags – PR bleeding, weight loss, change in bowel habit, FH bowel or ovarian Ca, age > 50
  • Others – abdominal pain relieved by BO, mucus, bloating, association with food
  • Examination – abdominal examination, PR

 

Clinical management

  • Investigations
    • Bloods – FBC, ESR, CRP, TFTs, TTG
    • Stool – faecal calprotectin, MC&S
  • Explanation
    • IBS is a condition that affects the function of the gut, it is thought that there may be some over-activity in some part of the bowel
  • Treatment
    • Fluid – 8 glasses of water/day, reduce fizzy drinks/caffeine/alcohol
    • Food – regular meals, limit fruit and high fibre diet
    • Exercise
    • Medications – see below
    • CBT (if not improved in 12 months)
  • Follow-up / Safety-net / Refer
    • Consider dieticians – FODMAP diet
    • Consider gastroenterology

 

Medications

  • Antispasmodics
    • Mebeverine, Alverine, Peppermint oil
  • Antimuscarinics
    • Hyoscine Butylbromide (Buscopan)
  • Antimotility agents
    • Loperamide
  • Laxatives
    • Movicol (osmotic) or Fybogel (bulking) +-  Senna (stimulant)
  • TCA
    • Amitriptyline 10-50mg ON

 

Reference