Ibs - Dr. Michael Schultz

Facts about IBS Michael Schultz Dunedin Public Hospital

Red Flag Symptoms! Alarm features:  Age > 50  Short history of symptoms  Weight loss  Nocturnal symptoms!  Male  FHx of CRC  Anaemia  PR bleeding  Recent antibiotic use

Rome III (2006) Recurrent abdo pain/discomfort  3 days per month for the previous 3 months Plus two or more symptoms:  Improvement with defaecation  Associated with change in frequency  Associated with change in stool form Supporting symptoms: • Straining/urgency • Mucus • Bloating/distention

Diagnostic Algorithm DD: Microscopic colitis Coeliac disease Giardia Lactose intolerance Bacterial overgrowth Bile malabsorption CRC

Clinical History

Suspected IBS predominant symptom

diarrhea

pain

constipation

1st level: FBC, coeliac antibodies (0-3%), HADS questionnaire ESR/CRP, stool cultures

Amylase, faecal elastase, CT, U/S

2nd level: colonoscopy, gastroscopy, faecal calprotectin

GP

Specialist

GUT 2007

Treatment Algorithm IBS predominant symptom

diarrhea • • • • •

pain

Cognitive behavioral therapy Psychological treatment Hypnotherapy Dietary challenges – fibers or not? Probiotics 5-HT3 agonists

5-HT3 antagonists • antispasmodics •trycyclic antidepressiva

constipation