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Irritable bowel syndrome

Definition
  • A functional gastrointestinal disorder characterised by chronic abdominal pain and altered bowel habits in the absence of any organic cause.
Aetiology
  • Exact cause unknown.
  • Possible factors: altered gut motility, visceral hypersensitivity, post-infectious changes, imbalance in gut microbiota, food intolerances, and psychological factors.
Classification
  • Based on predominant bowel symptom:
    • IBS-C: Constipation predominant
    • IBS-D: Diarrhoea predominant
    • IBS-M: Mixed bowel habits
Clinical Features
  • Abdominal pain or discomfort, often relieved by defecation.
  • Bloating and abdominal distension.
  • Altered bowel habits (constipation, diarrhoea, or alternating).
  • Nocturnal diarrhoea, blood in stools, and weight loss are NOT typical of IBS and should prompt further investigation.
Diagnostic Criteria (Rome IV)
  • Recurrent abdominal pain, on average, at least 1 day/week in the last 3 months, associated with two or more of the following criteria:
    • Related to defecation
    • Change in frequency of stool
    • Change in form (appearance) of stool
  • Symptoms must be present for the last 3 months with symptom onset at least 6 months before diagnosis.
Investigations
  • Mostly a clinical diagnosis.
  • Basic tests: Full blood count, coeliac serology, CRP/ESR to exclude other conditions.
  • Colonoscopy: If there are any red flag symptoms (e.g. weight loss, rectal bleeding).
Management
  • Dietary and lifestyle: Regular meals, reduced caffeine/alcohol, low FODMAP diet.
  • Pharmacological: Laxatives (for IBS-C), antispasmodics (e.g. mebeverine), and antidiarrhoeals (e.g. loperamide for IBS-D).
  • Psychological therapies: Cognitive behavioural therapy, hypnotherapy, and psychotherapy have shown benefit in some patients.
Prognosis
  • IBS is a chronic condition, but it does not increase the risk for more serious conditions like colon cancer.
  • Many people can manage symptoms with lifestyle changes, diet, and medications.

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