Irritable Bowel Syndrome. Dr Alan Shand MD, FRCP (Edin) Consultant Gastroenterologist Edinburgh Gastroenterology

Transcription

1 Irritable Bowel Syndrome Dr Alan Shand MD, FRCP (Edin) Consultant Gastroenterologist Edinburgh Gastroenterology

2 Summary Definition of IBS-what is it? Epidemiology-who gets it? Pathophysiology-what is happening? Treatment Non drug treatments Drugs Personal view-importance of the individual

3 Definition of IBS-what is it? Abdominal pain Bloating (gas, distension) Change in bowel habit (more or less often, stools softer or firmer) Symptoms for >6 months Can have Lethargy, back pain, nausea, bladder disturbance

4 Definition of IBS-what isn t it? Red flag symptoms Weight loss Rectal bleeding Abnormal blood tests (anaemia, inflammation) Abnormal examination (abdomen, rectum) Further caution in Over 60s Family history of bowel or ovarian cancer Nocturnal disturbance

5 Epidemiology-who gets it? Up to 20% of population affected at any one time (may be even more) year olds most commonly F:M 2:1 75% of people deal with symptoms themselves

6 Pathophysiology-what is happening? Altered gut sensation Visceral hypersensitivity Abnormal nociception Effects of previous injuries (infection, surgery) Effects of stress Altered gut bacteria Increased gas production Stress Modern life(styles) Diet

7 Gut function

8 Gut/Brain axis" BRAIN Information from Gut to Brain Information from Brain to Gut Pressure sensors Gut nervous system Hormones Hollow tube Central nervous system Gut nervous system Altered motor function Altered absorption Altered sensation

9 Increased pressure-distension Hollow tube

10 Increased pressure-muscular spasm Hollow tube

11 Over stimulation of pressure sensors Hollow tube

12 Gut sensation Pressure sensor Hollow tube

13 Visceral hypersensitivity BRAIN Hollow tube

14 Non drug treatments Explanation, reassurance, exclude other problems Search for triggers Stress, pressure, deadlines, uncertainty Foods Fibre Hypnotherapy Acupuncture Herbal remedies Homeopathy Pyschological treatments

15 Excluding other causes History and examination vital Anti-tTG FBC TFTs Faecal calprotectin may have a role Under 45s Absence of weight loss, rectal bleeding, anaemia

16 Approach to treatment Brief decision aid Simply understanding the diagnosis Making changes to eating patterns Using medications Trying treatments which treat body & mind together

17 Simply understand the diagnosis Provide literature, web based information patient.co.uk Discuss & address links between gut and brain links to anxiety, depression NOT all in the mind, in the gut as well...

18 Making changes to eating behaviour Diet-where to start? Eat regular meals (especially breakfast) Don t skip meals Don t eat late at night Take time over meals, sit down, chew well Exercise regularly Make time to relax Alter diet according to your symptoms

19 Wind & Bloating Limit fruit to 3 portions per day Limit fruit juice to 1 small glass Reduce resistant starches Oats, golden linseeds may help Consider probiotics

20 Resistant starch Complex carbohydrates not readily broken down in small intestine Fermentation by colonic flora Most sources of fibre (bran, wholegrains etc) Dried pasta (consider using fresh) Reheated carbohydrate (convenience, ready meals) Garlic bread, pizza, part baked products Reheated potato- oven chips, wedges, mash Reheated pasta- lasagne

21 Diarrhoea Limit fizzy drinks Limit alcohol Limit caffeine Limit insoluble fibre Limit fatty foods Limit resistant starches Limit artificial sweeteners Consider probiotics

22 Constipation Increased fibre will help most people but will increase gas and bloating for many Increase fibre as tolerated Ensure adequate intake of water Oats, golden linseeds Adequate levels of exercise Consider probiotics

23 Using medication-general points Safety is paramount High placebo response Some evidence from meta-analyses emerging to give guidance

24 Using medication What works? Soluble fibre Psyllium (ispaghula) husk Antispasmodics Peppermint oil Antidepressants Tricyclics, SSRIs May need to try several agents in turn

25 Using medication -the future Ondansetron (4mg tid) Effective in IBS-d Future possibilities Target Gut/Brain axis Block CRH Safety first...

26 Treating body & mind together Cochrane database reviews Hypnotherapy Psychological therapies Acupuncture Herbal remedies Generally fairly limited evidence for efficacy No evidence for harm

27 Personal viewthe importance of the individual Identify IBS from the start Exclude other conditions if necessary Explanation, reassurance Address triggers if possible Diet changes Antispasmodics, low dose imipramine Complementary therapies Keep trying different approaches Do what works for the individual

28 Any Questions

29 Useful Links s/578499/irritable-bowel-syndrome.html