Irritable bowel syndrome: Difference between revisions
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+ | == Background == |
* Syndrome characterized by abdominal pain or discomfort and altered bowel movements |
* Syndrome characterized by abdominal pain or discomfort and altered bowel movements |
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* May be diarrhea- or constipation-predominant, or mixed |
* May be diarrhea- or constipation-predominant, or mixed |
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− | == Etiology == |
+ | === Etiology === |
− | * Post-infectious IBS |
+ | * [[Post-infectious IBS]] |
+ | * Idiopathic |
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− | * Idiopathy |
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− | == Epidemiology == |
+ | === Epidemiology === |
* Prevalence of 10-15% in North America |
* Prevalence of 10-15% in North America |
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== Differential Diagnosis == |
== Differential Diagnosis == |
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− | * Celiac disease |
+ | * [[Celiac disease]] |
− | * Inflammatory bowel disease (IBD) |
+ | * [[Inflammatory bowel disease]] (IBD) |
− | * Microscopic colitis, especially in older patients |
+ | * [[Microscopic colitis]], especially in older patients |
− | * Overflow diarrhea, especially in older patients |
+ | * [[Overflow diarrhea]], especially in older patients |
* Others |
* Others |
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− | ** Chronic infection (e.g. Giardia, Entamboeba) |
+ | ** Chronic infection (e.g. [[Giardia]], [[Entamboeba]]) |
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== Investigations == |
== Investigations == |
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* Other |
* Other |
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** Colonoscopy, if over 50 years old or alarm features, to rule out microscopic colitis and IBD |
** Colonoscopy, if over 50 years old or alarm features, to rule out microscopic colitis and IBD |
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+ | == Diagnosis == |
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+ | * Made based on Rome Diagnostic Criteria and the exclusion of other causes of their symptoms |
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== Management == |
== Management == |
Latest revision as of 09:12, 3 June 2021
Background
- Syndrome characterized by abdominal pain or discomfort and altered bowel movements
- May be diarrhea- or constipation-predominant, or mixed
Etiology
- Post-infectious IBS
- Idiopathic
Epidemiology
- Prevalence of 10-15% in North America
Differential Diagnosis
- Celiac disease
- Inflammatory bowel disease (IBD)
- Microscopic colitis, especially in older patients
- Overflow diarrhea, especially in older patients
- Others
- Chronic infection (e.g. Giardia, Entamboeba)
Investigations
- Labs
- Celiac disease
- Anti-TTG +/- IgA levels
- HLA DQ2/DQ8, when already on gluten-free diet
- IBD
- ESR/CRP
- Fecal calprotectin
- Celiac disease
- Imaging
- AXR, to rule out overflow diarrhea
- Other
- Colonoscopy, if over 50 years old or alarm features, to rule out microscopic colitis and IBD
Diagnosis
- Made based on Rome Diagnostic Criteria and the exclusion of other causes of their symptoms
Rome Diagnostic Criteria
- Recurrent abdominal pain for >= 3 days per month for >= 3 months
- Two of the following:
- Symptoms improve with bowel movements
- Associated with a change in stool frequency
- Associated with a change in stool consistency
Management
- Provide reassurance and education
- Lifestyle modification
- Small, frequent meals
- Avoid fatty foods
- Increased physical activity
- May try:
- Lactose avoidance
- Gluten- or FODMAPS-free diet
- Dietary fibre may help or harm
- If bloating: avoid beans/dried fruit/bananas
- Medical therapy
- Mild IBS
- Antispasmodics (butylscopolamine (Buscopan), scheduled or prn)
- Anti-diarrheals (Immodium prn) for diarrhea-predominant
- Probiotics (Align and Tuzen)
- Moderate or severe IBS
- Tricyclic antidepressants (6-8 weeks to take effect)
- SSRIs if concurrent depression
- CBT and hypnotherapy
- Rifaximin
- Linaclutide (Constella) for consipation-predominant
- Mild IBS