Irritable Bowel Syndrome Worksheet

1. What is IBS? Discuss the diagnostic criteria for IBS along with incidence in the World
population.

2. Characteristics of the disease

Characteristics Description

Aetiology

Pathophysiology

Disease-Related Symptoms

Associated Conditions

Primary Dietary Objectives

Risk Factors

Medications

HAMEED LATIF HOSPITAL Department of Clinical Nutrition

CARE, CONCERN, COMPASSION Internship Program
created by
Syeda Zainab Abbas
3. The diagnosis of IBS includes interpretation of some diagnostic tests. Identify which tests will be
used and what their significance is.

Test Significance

4. What is a differential diagnosis? How can a healthcare professional differentiate between IBS &
IBD (both ulcerative colitis and crohn’s disease) as well as colorectal carcinoma in terms of general
appearance of the patient, pain level, stool habits, clinical features, symptoms, treatment as well as
incidence and Medical Nutrition Therapy etc?

HAMEED LATIF HOSPITAL Department of Clinical Nutrition

CARE, CONCERN, COMPASSION Internship Program
created by
Syeda Zainab Abbas
5. Identify the 6 major diet suggestions for IBS and explain your reasoning.

6. Illustrate the Bristol Stool Chart and elaborate on the importance of stool patterns in IBS.

HAMEED LATIF HOSPITAL Department of Clinical Nutrition

CARE, CONCERN, COMPASSION Internship Program
created by
Syeda Zainab Abbas
7. What are FODMAPs? Define them and explain why should they be avoided in IBS?

Food Group Serving Size Low FODMAP Mid FODMAP High FODMAP

Fruits

Vegetables

Dairy

Grains

Beverages

Sweeteners

HAMEED LATIF HOSPITAL Department of Clinical Nutrition

CARE, CONCERN, COMPASSION Internship Program
created by
Syeda Zainab Abbas
8. Why do some patients need to follow a low fructose diet? What are some of the names for
fructose you can find in product ingredients? Also complete the following table for fructose content
of foods from different food groups.

Food Group Serving Size Intestine friendly Foods to limit Foods to avoid

Fruits

Vegetables

Sweeteners

Other foods

HAMEED LATIF HOSPITAL Department of Clinical Nutrition

CARE, CONCERN, COMPASSION Internship Program
created by
Syeda Zainab Abbas
9. Critically analyze the use of probiotics as a form of therapy for IBS?

10. Make a list of foods rich in soluble fibre with serving sizes , food group & amount of fibre (g)

HAMEED LATIF HOSPITAL Department of Clinical Nutrition

CARE, CONCERN, COMPASSION Internship Program
created by
Syeda Zainab Abbas
11. Amna is a 42-year old female who presented at the gastroenterology OPD. She had a history of
diarrhoea and constipation for yeas. Her stool cultures were negative with a colonoscopy negative
for active disease. She has a medical history of hypothyroidism, GERD and obesity and has had 2
cesarian sections in the past.

She takes Omeprazole 50mg BD, Levothyroxine 25mg, vitamin D 600 IU, Calcium 800mg and
lomotil prn.

She has a family history of Hypertension and atherosclerosis (Father) and hypothyroidism alongside
type 2 diabetes (Mother and Sister). She has hyperactive bowel sounds with a lower abdomen
tenderness.

The patient meets the Rome III criteria for IBS-D and has a Blood glucose level of 115mg/dL,
Cholesterol 201mg/dL, TG 171mg/dL and HbA1c 6.1%. She will begin Elavil 25 mg daily and initiate
Metamucil 1 tbsp in 8 oz of liquid twice daily.

Amna has a sedentary 8-4 job at a preschool five days a week and is obese with a weight of 87kg
and a height of 165cm. She states that her appetite is good even with her abdominal pain and
diarrhea. She has steadily gained weight since her pregnancies and in the last 5 years has gained
over 20 lbs. She feels that there is not any one food that causes diarrhea more than others. She likes
most foods— likes to cook and prepares most meals at home. Patient states that she has been trying
to follow a high-fiber diet so that it might help with her gastrointestinal symptoms. Patient also asks
if her yogurt intake will provide enough probiotics as she has heard she needs to balance the
bacteria in her intestines. She does admit that she isn’t quite sure what that means.

Usual intake (for past several months):

Breakfast: Homemade yogurt smoothie with 1 c fresh fruit (peaches and cherries) + 8 oz
yogurt, or dry cereal with dried fruit, nuts mixed with yogurt; 2–3 c coffee with half
and half and artificial sweetener
Midmorning: Diet Pepsi, . c dried fruit and nuts
Lunch: Salad with kidney beans or lentils, cheese, tomatoes, carrots, asparagus; wheat
crackers—approx. 12–15, Diet Pepsi
Dinner: Some type of meat—varies, but mostly chicken; pasta or potatoes, variety of vegetables,
some type of bread or roll with butter
Snacks: Ice cream, cake, or cookies, usually each night but lately has been trying to eat
sugar-free candies to help with weight loss.

Develop a diet plan for Amna keeping in mind her BMI, BMR and preferences of foods.

HAMEED LATIF HOSPITAL Department of Clinical Nutrition

CARE, CONCERN, COMPASSION Internship Program
created by
Syeda Zainab Abbas
 Diet Plan

Meal Food Serving kcal

HAMEED LATIF HOSPITAL Department of Clinical Nutrition

CARE, CONCERN, COMPASSION Internship Program
created by
Syeda Zainab Abbas
1. Amna’s physician prescribed two medications for her IBS. What are they and what is the proposed
mechanism of each? She discusses the potential use of Lotronex if these medications do not help.
What is this medication and what is its mechanism? Identify any potential drug–nutrient
interactions for these medications.

2. For each of the following foods, outline the possible effect on IBS symptoms.
a. lactose
b. fructose
c. sugar alcohols
d. high-fat foods

HAMEED LATIF HOSPITAL Department of Clinical Nutrition

CARE, CONCERN, COMPASSION Internship Program
created by
Syeda Zainab Abbas
3. The Nutritionist that counsels Amna discusses the use of an elimination diet. How may this be
used to treat Mrs. Clarke’s IBS?

3. The Nutritionist discusses the use of the FODMAP assessment to identify potential trigger foods.
Describe the use of this approach for Amna. How might a food diary help her determine
which foods she should avoid? Should the Nutritionist recommend a probiotic supplement? If so,
what standards might the Nutritionist use to make this recommendation?

HAMEED LATIF HOSPITAL Department of Clinical Nutrition

CARE, CONCERN, COMPASSION Internship Program
created by
Syeda Zainab Abbas