Irritable bowel syndrome

Condition

• Irritable bowel syndrome

History

• chronic abdominal pain 
• altered bowel motions in the absence of an organic cause
• more common in women
• can present with wide array of symptoms including gastrointestinal and extra-intestinal complaints such as tiredness, sleeping difficulties and poor concentration

Examination

• apart from mild abdominal tenderness over the sigmoid colon, which is common, abdominal examination should be normal 

Diagnostic criteria

• ROME III Criteria for the diagnosis of IBS
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Investigations

• mainly to exclude other diseases
• FBE, Iron studies, UEC, CRP, TFTs, coeliac disease 
• the presence of the following symptoms usually suggest other disease 

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Management:

• Non pharmacological treatment
• Fibre restriction 
• dietary restrictions of lactose and/or fructose or FODMAPs 
• Probiotics: bifidobacteria and combination strains containing this bacteria, have shown some benefit in reducing IBS symptoms 
• Pharmacological treatment
• Antispasmodics - peppermint oil, hyoscine and mebeverine
• Antidiarrhoeals - loperamide 
• Antibiotics - rifaximin
• Antidepressants - TCAs and SSRIs
• Psychological therapies
• CBT and psychotherapy