Co1

IBS prevalence

Affects 10-20% of population (F > M)

IBS clinical presentation (Abdomen)

Abdominal cramping, flatulent or distension

IBS clinical presentation (Bowel habit)

Change bowel habit (alternating diarrhea & constipation)

IBS trigger (Psychological)

Stress and anxiety

IBS trigger (Dietary)

Dairy, caffeine, fatty or spicy food

IBS trigger (Post-infection)

Post-infectious IBS after gastroenteritis

IBS trigger (Hormonal)

Hormonal changes (worse during menstruation)

Rome IV criteria (Pain duration & frequency)

Chronic or recurrent abdominal pain at least 1 day per week during the previous 3-6 months

Rome IV criteria (Associated criteria count)

Associated with 2 or more criteria

Rome IV criteria (Criterion 1 - Defecation)

Related to defecation (relieved by defecation)

Rome IV criteria (Criterion 2 - Stool frequency)

Associated with a change in stool frequency

Rome IV criteria (Criterion 3 - Stool form)

Associated with a change in stool form

IBS initial lab investigations

CBC, ESR, CRP, stool analysis

IBS initial imaging & endoscopy

Abdominal x-ray, flexible sigmoidoscopy

IBS complications

Not serious, depression or anxiety

IBS prognosis (1 year improvement rate)

50% improve at one year

IBS prognosis (Worsening rate)

Worsen in only 5%

IBS lifestyle management (Habits & Stress)

Smoking & alcohol cessation, ↑ activity, ↓ stress (Yoga)

IBS lifestyle management (Diet general)

Regular meals, ↑ water intake, ↓ tea & coffee

IBS-C dietary modification

High fiber diet

IBS-D dietary modification

Avoid sweeteners and fiber diet

IBS-Flatulent medication options

Simethicone, activated charcoal

IBS-C medication options

Bulk-forming laxatives, methylcellulose or Metamucil

IBS-D medication options

Antidiarrheals (loperamide, diphenoxylate)

TCA for resistant IBS cases

Amitriptyline 10 to 50 mg

IBS Red flags (Physical & Lab)

Weight loss, loss of appetite, IDA, age > 50 years

IBS Red flags (GI bleeding & Liver)

Melena, persistent vomiting, hematemesis, jaundice

IBS differential diagnosis (Mechanical & Neoplastic)

Obstruction, malignancy

IBS differential diagnosis (Inflammatory & Metabolic)

IBD, lactose intolerance