Diarrhea, Constipation, and IBS Pharmacotherapy Quiz

Constipation is a common gastrointestinal (GI) condition, affecting 1 in 4 adults and 4x more likely in the elderly

Associated factors include inactivity, lower socioeconomic class, lower income, non-white race, symptoms of depression, and history of physical or sexual abuse

Constipation can be primary (idiopathic) or secondary

Primary constipation can be divided into three categories: normal transit, slow transit, and pelvic floor dysfunction

Normal transit: normal GI motility and stool frequency but difficulty evacuating, hard stools, or bloating

Slow transit: abnormality of GI transit time leading to infrequent defecation

Pelvic floor dysfunction: muscles or sphincter contract during defecation instead of relaxing

Constipation treatment major goals are to relieve symptoms, reestablish normal bowel habits, and improve quality of life

Nonpharmacologic therapy includes dietary modification to gradually increase fiber intake, proper fluid intake, and pelvic floor retraining therapy

Pharmacologic therapy includes three types of laxatives and various other medications

Irritable Bowel Syndrome (IBS) is the most commonly diagnosed GI condition, affecting 10-12% of North Americans with a 2:1 female predominance

IBS is characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause

IBS likely results from altered somatovisceral and motor dysfunction of the intestine from a variety of causes

Known contributing factors include genetics, motility factors, inflammation, colonic infections, mechanical irritation to local nerves, and psychological factors

IBS treatment is based on the predominant symptoms and their severity, ranging from lifestyle changes to pharmacological agents

IBS-D treatment includes avoidance of certain food products, use of antidiarrheal or antispasmodic agents, and use of 5-HT3 receptor antagonists

IBS-C treatment includes use of dietary fiber, psyllium or PEG laxatives, and use of the Guanylate Cyclase-C agonist, Linzess© (linaclotide)

IBS can be treated with various medications, including tricyclic antidepressants, Duloxetine (SNRI), Eluxadoline (Viberzi©), rifaximin, and alosetron (Lotronex ©) (on REMS)

Tricyclic antidepressants and Duloxetine (SNRI) have shown some benefit in IBS-D with moderate to severe pain.

IBS treatment references include Diarrhea, Constipation, and Irritable Bowel Syndrome by Pharmacotherapy: A Pathophysiologic Approach.

Diarrhea is a common condition characterized by increased frequency and decreased consistency in bowel movements compared to an individual's normal pattern.

Diarrhea can be classified into four broad clinical groups: secretory, osmotic, exudative, and altered intestinal transport.

Diarrhea can be acute (lasting for less than 14 days) or chronic (lasting for more than 30 days).

Acute diarrhea can be caused by several factors, including food or waterborne viruses, bacteria, or protozoa, and is more prevalent in developing countries where it can lead to significant morbidity and mortality, especially among children.

Prevention of diarrhea can be achieved through environmental hygiene practices such as hand washing, proper food and water handling, and storage. Vaccines, such as the oral cholera vaccine and vaccines for typhoid and rotavirus, are also effective in preventing diarrhea.

Treatment of diarrhea aims to manage diet, prevent excessive water, electrolyte, and acid-base disturbances, provide symptomatic relief, and treat curable causes. Rehydration and water maintenance are essential treatment goals.

Diarrhea can be managed with various treatment options including opiates and derivatives, adsorbents, antisecretory agents, anticholinergic drugs, and lactase enzyme products.

Constipation is a common condition characterized by difficult or infrequent passage of stool, and can be acute or chronic depending on the duration of symptoms.

Constipation can affect up to 15% of the adult population worldwide, and is more common in women. Prevalence depends on the definition used and whether the condition is self or provider-reported.

Treatment for constipation involves addressing underlying causes, such as diet and lifestyle modifications, and may include medications and other interventions.