Irritable bowel syndrome

Chronic, relapsing/remitting condition

Women >>> men

Common in 20s/30s

Symptoms

• Pain
• Altered bowel habit
• Bloating

Subtypes

• IBS-D: diarrhoea
• IBS-C: constipation
• IBS-M: mixed or alternating

Exclude IBD/coeliac disease. Consider pancreatic cancer.

• Faecal calprotectin (use cutoff of 50ng/g) +/- colonoscopy, as long as cancer is not suspected
  • Should have scope if (as per NICE, although these guidelines conflict with Australian)
    • 40+ with unexplained weight loss and abdo pain
    • 50+ with unexplained PR bleeding
    • 60+ and iron deficiency anaemia/changes in bowel habit/occult blood
• FBE
• ESR
• CRP
• Coeliac serology

Management

• Dietary and lifestyle advice is initial cornerstone
  • Increase physical activity
  • Relaxation time
  • Eat regular meals, take time to eat them
  • Limit fibre (including fruit)
  • Reduce processed foods
  • Good fluid intake
  • Avoid caffeine
• If still getting symptoms, more specialist dietary advice
  • See dietician
  • Common triggers are insoluble fibre, fructose/sorbitol, caffeine, dairy, gluten
  • FODMAP diet can be useful (low fermentable oligosaccharides, disaccharides, monosaccharides and polyols)
• Constipation can be managed with linaclotide if it is a big problem (12 months)
• TCAs have a place, if antispasmodics, laxatives and loperamide haven't helped
• Probiotics can be helpful in some cases