Irritable Bowel Syndrome

NOTE: Inflammatory Bowel Disease (IBS) Vs Irritable Bowel Syndrome (IBS)

Inflammatory Bowel Disease

  • Classified as a disease
  • Can cause destructive inflammation and permanent harm to the intestines
  • The disease can be seen during diagnostic imaging
  • Ulcerative Colitis and Crohns Disease comes under IBD
  • Increased risk of colon cancer

Irritable Bowel Syndrome 

  • Classified as a syndrome (group of symptoms)
  • Does not cause inflammation; less common to requires hospitalisation or surgery
  • There is no sign of disease or abnormality during an exam of the colon- more symptomatic
  • Lower risk for colon cancer

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SYMPTOMS 

Irritable bowel syndrome (IBS) is a common, chronic, relapsing, and often life-long condition, mainly affecting people aged between 20 and 30 years. It is more common in women. Symptoms include abdominal pain or discomfort, disordered defaecation (either diarrhoea, or constipation with straining, urgency, and incomplete evacuation), passage of mucus, and bloating. Symptoms are usually relieved by defaecation. Obtaining an accurate clinical diagnosis of IBS prior to treatment is crucial.

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Non pharmacological treatment 

Diet and lifestyle changes are important for effective self-management of IBS. Patients should be  increase exercise, and advised to eat regularly, without missing meals or  gaps between meals

Dietary advice should also include, limiting fresh fruit consumption to no more than 3 portions per day. If an increase in dietary fibre is required, soluble fibre such as ispaghula husk, or foods high in soluble fibre such as oats should be considered. Insoluble fibre (e.g. bran) and ‘resistant starch’ should be reduced or discouraged as they may exacerbate symptoms.

Drinks
Water intake should be increased to at least 8 cups each day.  Caffeine, alcohol and fizzy drinks should be reduced or avoided. The artificial sweetener sorbitol should be avoided in patients with diarrhoea. Where probiotics are being used, continue it for at least 4 weeks and monitor the effects.

If a patient’s symptoms continues despite following lifestyle and dietary advice, single food avoidance and exclusion diets could be considered under the supervision of a dietitian or medical specialist.

Pharmacological Treatment

Antispasmodic drugs

such as alverine citrate, mebeverine hydrochloride and peppermint oil) can be taken in addition to dietary and lifestyle changes

Laxatives 
A laxative (excluding lactulose as it may cause bloating) can be used to treat constipation. Patients who have experienced chronic constipation for at least 12 months and have not responded to laxatives from different classes may be treated with linaclotide. For the relief of diarrhea, loperamide hydrochloride is the preferred first-line anti-motility drug. Patients with irritable bowel syndrome (IBS) should be educated on how to adjust their dose of laxatives or anti-motility drugs based on stool consistency, with the goal of achieving a soft, well-formed stool.

low-dose tricyclic antidepressant, such as amitriptyline hydrochloride [unlicensed indication], can be used for abdominal pain or discomfort as a second-line option in patients who have not responded to antispasmodics, anti-motility drugs, or laxatives. A selective serotonin reuptake inhibitor (SSRI) may be considered in those who do not respond to a tricyclic antidepressant [unlicensed indication].