Irritable Bowel Syndrome Notes

Irritable Bowel Syndrome

A group of abdominal symptoms for which no organic cause can be found

Females>Males

20-40yrs

Aetiology

• Psychological morbidity

• Stress

• Visceral hypersensitivity

• Diet

Clinical features

• Central/lower abdo pain (relieved by defeacation)

• Bloating

• Altered bowel habits

• Tenesmus

• PR mucus

• Symptoms increase with

  • Menstruation

  • Stress

  • Gastroenteritis

Examination often normal

Management

• Exclude other diagnoses

  • Bloods

  • Sigmoid/colonoscopy

• Education and reassurance

• Dietary manipulation

• Psychological therapies

• Pharmacological treatment

  • Pain

    • Antispasmodics e.g mebeverine

  • Diarrhoea

    • Antimotility e.g loperamide, codeine

  • Constipation

    • High fibre diet

Malabsorption

Common causes in UK

• Coeliac disease (can’t absorb)

• Chronic pancreatitis (can’t break down food)

• Crohn’s disease (can’t absorb)

Other causes

• Infection

• Pancreatic cancer

• Biliary obstruction

Coeliac Disease

T-cell mediated autoimmune disease of the small bowel causing inflammation of jejunal mucosa that improves when patient is treated with a gluten-free diet

Aetiology

• Familial link (HLA-DQ8+2)

• Gluten is contained in cereals, wheat, rye, barley

Pathogenesis

Gluten can break down to gliadin peptides

Damages small intestine mucosa

Mainly affects proximal small bowel

Damage decreases in severity towards ileum as gluten is digested into smaller “non-toxic” fragements

Histology

• Absent villi

• Crypt hyperplasia

• ...

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