Irritable Bowel Syndrome

1
Irritable Bowel Syndrome

• Definition
• Overview
• Evidence base for dietary advice
• Our audit
• Results
• Discussion
• Recommendations

2
IBS -Definition

• IBS is a common digestive disorder which can
  cause troublesome and persistent symptoms. These
  vary from person to person, but usually include
• abdominal pain
• bloating
• a change or disruption of bowel habit. This can
  range from constipation to diarrhoea, or can
  alternate between the two.
• IBS is also known as a functional
  gastrointestinal disorder as it occurs in the
  absence of any known structural pathology
• Anxiety and depression are commonly associated
  with IBS

3
Overview

• IBS is a common non-life threatening condition,
  affects 30 of adults
• Affects 1.5 -2 times as many women as men
• Costly to the NHS
• Over 50 of patients attending gastroenterology
  out-patient clinics have IBS

4
Overview continued
Some Causes of IBS Brain Gut Axis/psychological
factors stress/anxiety/depression Hypersensitive
gut Abnormalities of intestinal motility
spastic colon Antibiotics Diet
5
Evidence base for dietary advice

• Meal pattern
• Fibre (excess and lack of)???
• Caffeine
• Fluid (linked to fibre intake)
• Food intolerance wheat/lactose/sorbitol/fructose
• Exclusion diet
• Spicy foods
• Fatty foods
• Pre/probiotics

6
Our Audit- Somerset Community Dietitians

• What dietary advice are we giving and recording
  for IBS patients?
• Are we providing the best practice that is
  evidence based?

7
Our Audit Somerset Community Dietitians

• Used our database of all patient contacts from
  1/10/03 to 30/9/04
• Total contacts 6,483
• IBS contacts 103 (1.6)
• Of 103 13 DNA, 3 misdiagnosed,
• 3 unable to find record at GP surgery, 2 not
  audited 103 -21 82

8
Our Audit

• Age range 12 84 years
• Mean age 57 years
• female 56/82 68

9
Our Audit

• Each dietitian filled in a Dietary Advice Review
  Checklist of all the IBS patients seen
• This was then collated on a spreadsheet and the
  results calculated

10
Our Audit

• Somerset Community Dietitians
• IBS Audit
• Dietary Advice Review Checklist
• GP Practice
• Patients Name
• Date of Birth Gender
• Were the following subjects discussed during
  consultation with community dietitian? (circle
  response)
• Weight Measurement Yes / No BMI
• Meal Pattern Yes / No
• Fluid Intake Yes / No
• Exercise Yes / No
• Lifestyle / Stress Yes / No
• Caffeine Yes / No
• Alcohol Yes / No
• Spicy Foods Yes / No
• High Fat Foods Yes / No
• Fibre Intake Yes / No
• Pre / Probiotics Yes / No
• Fibre Supplements Yes / No

11
Results

• Meal pattern 51/82 62
• Fluid Intake 25/82 30
• Exercise 15/82 18
• Lifestyle/stress 22/82 27
• Caffeine 10/82 12
• Alcohol 11/82 13
• Spicy foods 23/82 28
• High fat foods 30/82 37
• Fibre 44/82 54
• Pre/probiotics 22/82 27
• Exclusion diet 36/82 44
• Leaflets specified 27/82 33

12
Discussion

• IBS patients make up a very small number of our
  total contacts, less than 2
• gt30 of diet advice recorded was
• Meal pattern
• Fibre/fluid intake
• High fat foods
• Exclusion diet (includes wheat/dairy/lactose
  free)
• Leaflets specified
• Dietary advice recorded covers most of the areas
  where there is evidence but the record keeping
  can be much improved
• Specific dietary advice may not be recorded but
  it may have been advised

13
Discussion continued

• The role of fibre needs to be clarified e.g.
  insol. versus sol., bran versus wholegrain
• More detail on the type of fibre in foods
• Patient information on fibre can be inconsistent
• What about some kind of stool assessment?

14
Recommendations

• Develop a specific diet advice check list for IBS
  patients that is scanned/filed in patients
  medical notes
• Buyin / Produce an improved diet leaflet for IBS
  patients that comprehensively covers the evidence
  for diet advice
• Make this resource available to all GP
  surgeries/health centres in the PCTs