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Irritable Bowel Syndrome PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Irritable Bowel Syndrome” by Dr Bruce Davies.

This medical PowerPoint presentation talks about Irritable Bowel Syndrome (IBS), a chronic digestive disorder that affects the large intestine (colon). It is characterized by symptoms such as abdominal pain, bloating, constipation, and diarrhea, or a combination of these symptoms.

Tags : Irritable Bowel Syndrome, chronic digestive disorder, large intestine, colon, Gastroenterology, Gastroenterology PowerPoint presentation

Published on : Apr 26, 2023 | Views : 1600 | Downloads : 0

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Irritable Bowel Syndrome Dr Bruce Davies www.bradfordvts.co.uk
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Sept 2001 Bruce Davies 2 Introduction First described in 1771. 50% of patients present <35 years old. 70% of sufferers are symptom free after 5 years. GPs will diagnose one new case per week. GPs will see 4-5 patients a week with IBS. Point prevalence of 40-50 patients per 2000 patients.
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Sept 2001 Bruce Davies 3 What Is IBS? A syndrome. One man’s constipation is another man’s normality. Cause unknown. 20% seem to start after an episode of gastroenteritis.
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Sept 2001 Bruce Davies 4 Diagnostic Criteria Rome 11 Diagnostic criteria. Manning’s Criteria.
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Sept 2001 Bruce Davies 5 Rome 11 Diagnostic Criteria. At least 12 weeks history, which need not be consecutive in the last 12 months of abdominal discomfort or pain that has 2 or more of the following: Relieved by defecation. Onset associated with change in stool frequency. Onset associated with change in form of the stool.
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Sept 2001 Bruce Davies 6 Rome 11 Diagnostic Criteria. Supportive symptoms. Constipation predominant: one or more of: BO less than 3 times a week. Hard or lumpy stools. Straining during a bowel movement. Diarrhoea predominant: one or more of: More than 3 bowel movements per day. Loose [mushy] or watery stools. Urgency.
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Sept 2001 Bruce Davies 7 Rome 11 Diagnostic Criteria. General: Feeling of incomplete evacuation. Passing mucus per rectum. Abdominal fullness, bloating or swelling.
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Sept 2001 Bruce Davies 8 Manning’s Criteria. Three or more features should have been present for at least 6 months: Pain relieved by defecation. Pain onset associated with more frequent stools. Looser stools with pain onset. Abdominal distension. Mucus in the stool. A feeling of incomplete evacuation after defecation.
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Sept 2001 Bruce Davies 9 Associated Symptoms In people with IBS in hospital OPD. 25% have depression. 25% have anxiety. Patients with IBS symptoms who do not consult doctors [population surveys] have identical psychological health to general population. In one study 70% of women IBS sufferers have dyspareunia.
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Sept 2001 Bruce Davies 10 Associated Symptoms Stressful life events are associated. Compared with controls people with IBS are less well educated and have poorer general health. Women:Men = 3:1.
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Sept 2001 Bruce Davies 11 Reasons to Refer Age > 45 years at onset. Family history of bowel cancer. Failure of primary care management. Uncertainty of diagnosis. Abnormality on examination or investigation.
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Sept 2001 Bruce Davies 12 Urgent Referral Constant abdominal pain. Constant diarrhoea. Constant distension. Rectal bleeding. Weight loss or malaise.
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Sept 2001 Bruce Davies 13 Subtypes Diarrhoea predominant. Constipation predominant. Pain predominant.
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Sept 2001 Bruce Davies 14 Differential Diagnosis Inflammatory bowel disease. Cancer. Diverticulosis. Endometriosis. A positive diagnosis, based on Manning’s criteria may provoke less anxiety than extensive tests.
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Sept 2001 Bruce Davies 15 Examination Results should be normal or non-specific. Abdomen and rectal examination. FBC, CRP. No consensus as to whether FOBs or sigmoidoscopy is needed.
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Sept 2001 Bruce Davies 16 Treatment Patients’ concerns. Explanation. Treatment approaches.
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Sept 2001 Bruce Davies 17 Patients’ Concerns. Usually very concerned about a serious cause for their symptoms. Take time to explore the patients agenda. Remember that investigations may heighten anxiety.
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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 symptoms in life.
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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.
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Sept 2001 Bruce Davies 20 Antidepressants Poor evidence for efficacy. Better evidence for tricyclics. Very little evidence for SSRIs.
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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.
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Sept 2001 Bruce Davies 22 Constipation Predominant. Increased fibre. Osmotic laxatives helpful. Ispaghula husk is one. Stimulant laxatives make symptoms worse. Lactulose may aggravate distension and flatulence.
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Sept 2001 Bruce Davies 23 Pain Predominant. Antispasmodics will help 66%. Mebeverine is probably first choice. Hyoscine 10mg qid can be added. Bloating may be helped by peppermint oil. Nausea may require metoclopramide.
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Sept 2001 Bruce Davies 24 Diet Dietary manipulation may help. Food intolerance is common food allergy is rare. Relaxation therapies may be useful adjunct.
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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.
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Sept 2001 Bruce Davies 26 Self-help IBS network, St John’s House, Hither Green Hospital, Hither Green Lane, London SE13 6RU
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Sept 2001 Bruce Davies 27 Audit? Numbers on repeat prescription for anti-spasmodics. Do they use their drugs as prescribed? What other medications do they use? Referral rates? What investigations are done? Protocol? Formulary?
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Sept 2001 Bruce Davies 28 Psychological Thoughts Should a mental health assessment always be done? Should all therapy be directed at psychological causes? Is IBS a physical or a somatisation disorder?