Irritable bowel syndrome ✅
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🌿 Irritable Bowel Syndrome (IBS) = chronic functional gut disorder.
⚠️ Not life-threatening, but impacts quality of life and work.
💡 Management = empathy, reassurance, symptom control.
📖 Overview
- Functional gastrointestinal disorder: abdominal pain, bloating, altered bowel habits.
- No structural pathology: normal endoscopy, CRP/ESR normal.
- Often comorbid with anxiety, depression, fibromyalgia.
- Major cause of GP visits & work absenteeism.
🧬 Pathophysiology & Risk Factors
- Brain–gut axis dysfunction → altered motility, visceral hypersensitivity, stress response.
- Triggers: psychosocial stress, post-infectious gut changes, microbiota alterations.
- ♀️ More common in women; prevalence declines with age.
- Psychiatric comorbidity increases risk/severity.
🩺 Clinical Features
- Symptoms ≥6 months.
- 🔑 Abdominal pain often relieved by defecation.
- 💩 Altered bowel habits:
- IBS-D: diarrhoea predominant
- IBS-C: constipation predominant
- IBS-M: mixed pattern
- Other: bloating, incomplete evacuation, mucus passage, nausea, dyspepsia, globus, atypical chest pain.
📌 Rome IV Criteria
- Recurrent abdominal pain ≥1 day/week for 3 months + ≥2 of:
- Related to defecation
- Change in stool frequency
- Change in stool form (appearance)
- Symptom onset ≥6 months before diagnosis.
🚩 Red Flags (exclude IBS)
- Unintentional weight loss ⚠️
- Rectal bleeding 🩸
- Iron-deficiency anaemia 🩺
- Nocturnal symptoms 🌙
- New onset >50 years
- Family history: colorectal cancer, IBD, coeliac disease
🔎 Investigations (NICE-guided)
- Primarily clinical (Rome IV) + exclusion of red flags.
- Basic screening: FBC, CRP/ESR, coeliac serology (anti-tTG/EMA), TFTs, U&E, LFTs.
- Colonoscopy / sigmoidoscopy only if alarm features present.
- OGD if upper GI symptoms significant.
⚕️ Stepwise Management (NICE NG61)
| Step | Management | Notes / Emojis |
| 1 |
Education & reassurance |
IBS is benign but chronic. Emphasise lifestyle, stress management 💡🧘♂️ |
| 2 |
Dietary modification |
- Soluble fibre for IBS-C 🌾
- Low FODMAP diet 🍏 reduces bloating & pain
- Avoid caffeine, alcohol, spicy/fatty foods ☕🍺🌶️
|
| 3 |
Medications 💊 |
- Antispasmodics (Mebeverine, Hyoscine) → pain/cramps
- Loperamide → IBS-D (caution: constipation)
- Osmotic laxatives (PEG, lactulose) → IBS-C 🚽
- Low-dose TCAs (Amitriptyline) → visceral pain, IBS-D
- SSRIs for IBS-C / anxiety 🧠
|
| 4 |
Psychological therapies 🧠 |
CBT, mindfulness, gut-directed hypnotherapy; address anxiety/depression |
| 5 |
Follow-up & monitoring 📊 |
Track symptoms, diet/medication response; reassess if new alarm features develop; support from GP/IBS nurse |
Cases
- IBS-D 💩: 29F, loose stools 5/day, post-prandial cramps. No red flags. Management: Low FODMAP diet, soluble fibre, loperamide PRN. Outcome: improvement.
- IBS-C 🚽: 34M, bowel motions every 4–5 days, bloating. No alarm features. Management: hydration, exercise, macrogol, linaclotide trial. Outcome: regularity improved.
- IBS-M 🔄: 41F, alternating constipation & diarrhoea, stress-triggered pain. Management: education, low FODMAP, peppermint oil, CBT. Outcome: reduced pain & bloating.
🧑⚕️ Teaching Commentary
IBS = functional GI disorder, diagnosed clinically with Rome IV criteria.
Subtypes: IBS-D 💩, IBS-C 🚽, IBS-M 🔄.
Red flags 🚩 indicate urgent investigation.
Stepwise, evidence-based management (NICE NG61): reassurance → diet → meds → psychological therapy.
Chronic but benign; quality-of-life impact can be substantial. Empathy & patient-centred care improve adherence ❤️
References 📚
