Irritable Bowel Syndrome (IBS)
About the disease & condition
Irritable Bowel Syndrome is a common functional gastrointestinal disorder characterised by chronic abdominal pain and altered bowel habits (diarrhoea, constipation, or both) in the absence of detectable structural or biochemical abnormalities.
Aetiology & Pathophysiology
- Aetiology: Multifactorial; contributions from gut-brain axis dysregulation, visceral hypersensitivity, altered gut motility, intestinal microbiota changes, and psychosocial factors (e.g., stress, anxiety).
- Pathophysiology: Abnormalities in gut-brain communication lead to heightened pain perception (visceral hypersensitivity), dysmotility, and immune activation with low-grade inflammation in some cases.
Symptoms & Signs
- Common symptoms: Recurrent abdominal pain or discomfort relieved by defecation. Altered stool frequency or form (e.g., loose/watery or hard/lumpy stools). Bloating, distension, and mucus in stool.
- Subtypes: IBS-D (diarrhoea-predominant), IBS-C (constipation-predominant), IBS-M (mixed). Red-flag symptoms (suggestive of organic disease): Unintended weight loss, nocturnal symptoms, fever, rectal bleeding, anaemia, family history of colorectal cancer or inflammatory bowel disease.
Diagnosis
- Clinical diagnosis: Based on Rome IV criteria (recurrent abdominal pain ≥1 day/week for ≥3 months, associated with ≥2 of: related to defecation, change in stool frequency, change in stool form).
- Exclusion of alarm features: Guide needs further testing.
- Limited testing (as indicated): CBC, CRP, ESR, celiac serology, thyroid function tests. Faecal calprotectin (to distinguish from IBD). Colonoscopy (if alarm features, age >50, or family history of colorectal cancer).
Management
- Non-pharmacological: Dietary modifications: Low FODMAP diet (fermentable oligo-, di-, monosaccharides, and polyols), fibre supplementation (e.g., psyllium).
- Stress reduction: Cognitive behavioural therapy, gut-directed hypnotherapy, and regular exercise.
- Pharmacological (symptom-targeted): Antispasmodics (e.g., hyoscine, dicyclomine) for pain. Antidiarrheals (e.g., loperamide) for IBS-D. Laxatives (e.g., polyethene glycol) for IBS-C. Gut-specific neuromodulators (e.g., tricyclic antidepressants, SSRIs) for pain and global symptoms. Rifaximin (for IBS-D with bloating), lubiprostone/linaclotide (for IBS-C).
Potential Complications
- Reduced quality of life: Chronic pain, anxiety, depression, social and occupational impairment.
- Nutritional deficiencies (if dietary restrictions are overly stringent).
- Unnecessary procedures due to misdiagnosis or overlapping symptoms.
Prevention & Follow-up
- Prevention: No known prevention; stress management and healthy diet may reduce flare-ups.
- Follow-up: Regular monitoring of symptoms and treatment response. Reassessment if new alarm features develop or symptoms change significantly. Long-term focus on symptom control and quality of life rather than cure.
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