Irritable bowel syndrome, IBS

Notes

## Basic introduction

  • IBS constitutes a group of symptoms, such as abdominal pain and changes in the pattern of bowel movements that occur over a long period of time, without clear evidence of underlying damage.

## Classification of IBS

  • IBS-D: where diarrhea is common
  • IBS-C: where constipation is common
  • IBS-M: where both diarrhea and constipation is common
  • IBS-U: where neither diarrhea nor constipation are common

## Complications of IBS

  • Anxiety
  • Chronic fatigue syndrome
  • Major depression
  • Missed work /school hours

## Causes of IBS

  • The cause is not fully understood
  • Bacterial overgrowth in the small intestines
  • Food allergy
  • Genetic factors
  • Gut motility disorders
  • Gut–brain axis disorders

## Factors that are known to trigger IBS

  • Infection(s) in the intestines
  • Stress

## Statistics

  • Globally, reported prevalence of IBS varies from 1- 45%.
  • Prevalence of IBS in Kenya is 8% with male to female ratio of 1.4:1

Peak prevalence age is 20-30yrs

Symptoms
  • Abdominal pain
  • Diarrhea or constipation
  • Tenesmus
  • Backache
  • Bloating
  • Chronic fatigue syndrome
  • Anxiety
  • Depression
  • Fibromyalgia
  • Gastroesophageal reflux
  • Genitourinary system disorders
  • Headache
  • Reduced libido
Diagnosis
  • Clinical review
  • Tests to exclude other conditions:

_Stool microscopy and culture

_Full Blood Count (FBC)

_Abdominal ultrasound

_Endoscopy and biopsies

_ESR

_Hydrogen breath testing

_LFTs

_CRP

Differential
  • Amebiasis
  • Colon cancer
  • Giardiasis
  • Diverticular disease.
  • Inflammatory bowel disease (IBD) mainly Crohn's disease and ulcerative colitis.
  • Thyroid disorders
  • Gallstones and other biliary tract diseases
  • Peptic ulcer disease
  • Fructose and lactose malabsorption
  • Pelvic inflammatory disease
  • Endometriosis
  • Ovarian tumors
  • Anxiety
  • Depression
Prevention
  • Low FODMAPs diet
  • Relaxation
  • Some physical activities
Reference

1.Kenyan Ministry of Health. Clinical guidelines for management and referral of common conditions at levels 4-6. Hospitals. 2009; 3:259-261.http://apps.who.int/medicinedocs/documents/s21000en/s21000en.pdf

2. Barrett JS; Extending our knowledge of fermentable, short-chain carbohydrates for managing gastrointestinal symptoms. Nutr Clin Pract. 2013 Jun;28 (3):300-6.

3. Ministry of Health, Kenya. Kenya Essential Medicine List (2016). http://publications.universalhealth2030.org/uploads/KEML-2016Final-1.pdf

4. Definition and Facts for Irritable Bowel Syndrome". NIDDKD. 23 February 2015. Retrieved 29 March 2016

5. Talley NJ (2006). "Irritable bowel syndrome". Intern Med J. 36 (11): 724–8.

6. Lule GN, Amayo EO. Irritable bowel syndrome in Kenyans. East Afr Med J. 2002 Jul;79(7):360-3.

Management
  • There is no known cure for IBS
  • Relaxation and some physical activities
  • Take regular meals
  • Avoid alcohol and fizzy drinks
  • Take plenty of fluids (with minimum coffee and tea)
  • In a case of IBS-C adding high-fiber foods such as whole meal flour or bran may help
  • In a case of IBS-D limiting high-fiber foods such as whole meal flour or bran may help
  • Foods low in Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs)

## High FODMAPs diet (NOT recommended for IBS patient)

  • Vegetables: Asparagus, onions, garlic, legumes/pulses, beetroot, and Savoy cabbage
  • Fruits: Apples, pears, mango, watermelon, peaches and plums
  • Milk and dairy: Cow’s milk, yogurt, soft cheese, cream, custard, ice cream
  • Protein sources: Legumes/pulses
  • Breads and cereal: Wheat-containing breads, wheat-based cereals with dried fruit and wheat pasta.
  • Biscuits (cookies) and snacks: Rye crackers, wheat-based biscuits
  • Nuts and seeds: Cashews

## Low FODMAPs diet (Recommended for IBS patient)

  • Vegetables: Green beans, capsicum, carrot, cucumber, lettuce, and tomato
  • Fruits: Banana, orange, grapes and melon
  • Milk and dairy: Lactose-free milk, lactose-free yogurts, hard cheese
  • Protein sources: Meats, fish and chicken
  • Breads and cereal: Gluten-free bread, oats, gluten-free pasta, and rice
  • Biscuits (cookies) and snacks: Gluten-free biscuits, rice cakes, corn thins
  • Nuts and seeds: Almonds and pumpkin seeds
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