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1、Irritable Bowel Syndrome,Dr Bruce Davieswww.bradfordvts.co.uk,Sept 2001,Bruce Davies,2,Introduction,First described in 1771. 50% of patients present 45 years at onset. Family history of bowel cancer. Failure of primary care management. Uncertainty of diagnosis. Abnormality on examination or investig
2、ation.,Sept 2001,Bruce Davies,12,Urgent Referral,Constant abdominal pain. Constant diarrhoea. Constant distension. Rectal bleeding. Weight loss or malaise.,Sept 2001,Bruce Davies,13,Subtypes,Diarrhoea predominant. Constipation predominant. Pain predominant.,Sept 2001,Bruce Davies,14,Differential Dia
3、gnosis,Inflammatory bowel disease. Cancer. Diverticulosis. Endometriosis.A positive diagnosis, based on Mannings criteria may provoke less anxiety than extensive tests.,Sept 2001,Bruce Davies,15,Examination,Results should be normal or non-specific. Abdomen and rectal examination. FBC, CRP. No consen
4、sus as to whether FOBs or sigmoidoscopy is needed.,Sept 2001,Bruce Davies,16,Treatment,Patients concerns. Explanation. Treatment approaches.,Sept 2001,Bruce Davies,17,Patients Concerns.,Usually very concerned about a serious cause for their symptoms. Take time to explore the patients agenda. Remembe
5、r that investigations may heighten anxiety.,Sept 2001,Bruce Davies,18,Explanation.,Must offer a plausible reason for symptoms. Even if cause is unknown, patients require some explanation. Drawing a parallel with baby colic may help. Stress is currently a socially acceptable explanation for many symp
6、toms in life.,Sept 2001,Bruce Davies,19,Treatment Approaches.,Placebo effect of up to 70% in all IBS treatments. Treatment should depend on symptom sub-type. Often considerable overlap between sub-groups.,Sept 2001,Bruce Davies,20,Antidepressants,Poor evidence for efficacy. Better evidence for tricy
7、clics. Very little evidence for SSRIs.,Sept 2001,Bruce Davies,21,Diarrhoea Predominant.,Increasing dietary fibre is sensible advice. Fibre varies, 55% of patients will get worse with bran. “Medical fibre” adds to placebo effect. Loperamide may help.,Sept 2001,Bruce Davies,22,Constipation Predominant
8、.,Increased fibre. Osmotic laxatives helpful. Ispaghula husk is one. Stimulant laxatives make symptoms worse. Lactulose may aggravate distension and flatulence.,Sept 2001,Bruce Davies,23,Pain Predominant.,Antispasmodics will help 66%. Mebeverine is probably first choice. Hyoscine 10mg qid can be add
9、ed. Bloating may be helped by peppermint oil. Nausea may require metoclopramide.,Sept 2001,Bruce Davies,24,Diet,Dietary manipulation may help. Food intolerance is common food allergy is rare. Relaxation therapies may be useful adjunct.,Sept 2001,Bruce Davies,25,Referral,About 15% of patients seen by GPs with IBS are referred. Gastroenterology Mainly upper GI symptoms. General Surgical Lower GI symptoms.,Sept 2001,Bruce Davies,26,Self-help,
