Irritable bowel syndrome (IBS)

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Background:

  • Irritable bowel syndrome (IBS) affects 10-20% of the adult population
  • Females are twice as likely to present as males
  • Symptoms are most common in those ages 20-30

Consider a POSITIVE diagnosis of IBS in patients with any of the following symptoms for >6 months:

  • Abdominal pain related to defaecation
  • Change in bowel habit
  • Change in stool form

Features such as bloating, lethargy, nausea, backache and bladder symptoms are common in people with IBS and may be used to support the diagnosis.

NOTES.

  1. Family history of colon cancer is especially relevant if a first degree relative (FDR) <50yrs is affected, or if there are 2 FDRs affected at an older age.
  2. Faecal calprotectin is useful in identifying patients with a higher probability of organic colonic disease.
  3. In patients with persistent watery diarrhoea not responding to Rx, consider the possibility of microscopic colitis and possible need for colonic biopsies. Consider stopping PPI therapy.

IBS Post-Diagnostic Management and Referral Pathway

 

 

 

General points

  • Irritable Bowel Syndrome is NOT a diagnosis of exclusion
  • It can be diagnosed POSITIVELY using
    • Suggestive clinical criteria
    • Absence of red flag symptoms
    • Negative screening tests for coeliac disease (serology) and IBD (faecal calprotectin)
  • Once a POSITIVE diagnosis has been made, treatment is consists of reassurance and symptom relief.
  • This requires a very good understanding of what the symptoms are so a good history is vital
  • Asking the patient to complete a symptom diary over 4 weeks is very helpful in clarifying the main symptoms
  • Different approaches to treatment work better for different individuals and it is often necessary to trial a number of different approaches before settling on one which is most effective.
  • A failure of one or two therapies is frustrating but common. It is not, in itself an indication that the primary diagnosis is wrong.

Outline of therapy

  1. Selection of diet, drug or psychological interventions will be influenced by patient preference and local availability. Combination approaches may be appropriate for some patients.
  2. Drug therapies “below the line” should currently be regarded as primarily for specialist initiation.

Management

 

 

 

bor.gastroenterology@borders.scot.nhs.uk

Editorial Information

Author(s): Jonathan Fletcher, Angus Wallace.

Author email(s): bor.gastroenterology@borders.scot.nhs.uk.