Makindo Medical Notes

🌿 Irritable Bowel Syndrome (IBS) is a chronic relapsing functional gut disorder. ⚠️ Not life-threatening, but can severely impact quality of life and work. 💡 Management requires empathy, reassurance, and symptom control.

📖 About

• Common functional GI disorder with abdominal pain, bloating, and altered bowel habits.
• No structural pathology: normal endoscopy, no raised CRP/ESR, normal colonoscopy.
• Often overlaps with anxiety, depression, and other functional disorders (e.g., fibromyalgia).
• Healthcare burden: major cause of GP visits & work absenteeism.

🧬 Aetiology

• Abnormal brain–gut axis: altered motility, visceral hypersensitivity, stress responses.
• Triggered by psychosocial factors, gut microbiota changes, post-infectious states.
• ♀️ More common in women; frequency declines with age.
• Higher prevalence in those with psychiatric comorbidity (anxiety, depression, somatisation).

🩺 Clinical Presentation

• Symptoms for ≥6 months.
• 🔑 Abdominal pain – often relieved by defecation.
• 💩 Altered bowel habit: – IBS-D (diarrhoea predominant) – IBS-C (constipation predominant) – IBS-M (mixed, alternating)
• Other features: – Incomplete evacuation – Passage of mucus – Bloating, nausea, dyspepsia – Globus sensation, atypical chest pain (extracolonic symptoms)

📌 Rome IV Diagnostic Criteria

• Recurrent abdominal pain, on average ≥1 day/week in the last 3 months, associated with ≥2 of: – Related to defecation – Associated with change in stool frequency – Associated with change in stool form (appearance)
• Onset ≥6 months before diagnosis.

💡 Supportive Symptoms

• Abnormal stool frequency (>3/day or <3/week).
• Abnormal stool consistency (hard/lumpy or loose/watery).
• Straining, urgency, incomplete evacuation.
• Mucus passage.
• Abdominal distension or bloating.

🚩 Red Flags (Not IBS → urgent investigation)

• Unintentional weight loss.
• Rectal bleeding.
• Anaemia (iron deficiency).
• Nocturnal symptoms (waking from sleep).
• Onset >50 years.
• Family history: colorectal cancer, IBD, coeliac disease.

🔎 Investigations

• Diagnosis = clinical (Rome IV) + exclusion of red flags.
• Basic screening tests: – FBC (anaemia) – CRP/ESR (inflammation) – Coeliac serology (anti-tTG/EMA) – TFTs, U&E, LFTs as appropriate
• Colonoscopy/sigmoidoscopy if alarm features.
• OGD if upper GI symptoms.

⚕️ Management

• 🧑‍⚕️ Education & reassurance: IBS is benign but chronic. Emphasise lifestyle, stress management.
• 🥗 Dietary strategies: – Soluble fibre for IBS-C (avoid insoluble bran). – Low FODMAP diet: reduces bloating & pain. – Avoid caffeine, alcohol, spicy/fatty foods, carbonated drinks.
• 💊 Medications: – Antispasmodics (Mebeverine, Buscopan) → pain/cramps. – Loperamide → IBS-D (caution: constipation). – Osmotic laxatives (PEG, lactulose) → IBS-C (avoid stimulants). – TCAs (e.g., Amitriptyline low dose) → IBS-D, visceral pain. – SSRIs sometimes for IBS-C.
• 🧠 Psychological support: – CBT (evidence-based for IBS). – Relaxation therapy, mindfulness, hypnotherapy. – Address comorbid anxiety/depression.

💡 Teaching Pearls:
– IBS = functional disorder, no structural abnormality. – Rome IV is diagnostic backbone. – Red flags always prompt colonoscopy. – Management = stepwise → reassurance → diet → drugs → psychological support. – Be empathetic: quality of life impact is often underestimated.