Podcast
Questions and Answers
What is the effect of Linaclotide on patients with IBS-C?
What is the effect of Linaclotide on patients with IBS-C?
What is the primary function of Loperamide in treating IBS-D?
What is the primary function of Loperamide in treating IBS-D?
What type of medications are Dicyclomine and hyoscyamine?
What type of medications are Dicyclomine and hyoscyamine?
What is the potential use of Tricyclic antidepressants (TCAs) in IBS patients?
What is the potential use of Tricyclic antidepressants (TCAs) in IBS patients?
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What is the mechanism of action of Rifaximin in IBS patients?
What is the mechanism of action of Rifaximin in IBS patients?
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What precaution should be taken when using Rifaximin in IBS patients?
What precaution should be taken when using Rifaximin in IBS patients?
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Which of the following medications is specifically approved for treating IBS-C in women age 18 years and older?
Which of the following medications is specifically approved for treating IBS-C in women age 18 years and older?
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What is the effect of Psyllium on gas production?
What is the effect of Psyllium on gas production?
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What is a primary goal of therapy for IBS?
What is a primary goal of therapy for IBS?
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What is the first line therapy for constipation-predominant symptoms (IBS-C)?
What is the first line therapy for constipation-predominant symptoms (IBS-C)?
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What is a common symptom of IBS that is relieved with defecation?
What is a common symptom of IBS that is relieved with defecation?
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What is the purpose of Barium enema, sigmoidoscopy, or colonoscopy in IBS diagnosis?
What is the purpose of Barium enema, sigmoidoscopy, or colonoscopy in IBS diagnosis?
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What is the mode of action of peppermint oil in IBS?
What is the mode of action of peppermint oil in IBS?
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What is the category of IBS characterized by constipation-predominant symptoms?
What is the category of IBS characterized by constipation-predominant symptoms?
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What is a characteristic of IBS diagnosis?
What is a characteristic of IBS diagnosis?
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What is the characteristic of abdominal pain or discomfort in IBS?
What is the characteristic of abdominal pain or discomfort in IBS?
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What is the main characteristic feature of IBS?
What is the main characteristic feature of IBS?
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What are the three types of IBS classified into?
What are the three types of IBS classified into?
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What is the 'brain-gut axis' responsible for in IBS?
What is the 'brain-gut axis' responsible for in IBS?
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Which neurochemical is particularly important in the GI tract?
Which neurochemical is particularly important in the GI tract?
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What is the effect of 5-HT3 receptor stimulation in IBS?
What is the effect of 5-HT3 receptor stimulation in IBS?
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Some IBS patients demonstrate sensitivity to which common food?
Some IBS patients demonstrate sensitivity to which common food?
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What is thought to be involved in IBS patients?
What is thought to be involved in IBS patients?
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What is the 'brain-gut axis' responsible for in IBS?
What is the 'brain-gut axis' responsible for in IBS?
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Study Notes
Irritable Bowel Syndrome (IBS)
- IBS is a functional bowel disorder (FBD) characterized by recurrent abdominal pain associated with defecation or a change in bowel habits.
- IBS involves abdominal pain and bloating associated with a change in bowel habits.
Classification of IBS
- IBS is classified into three types:
- Constipation predominant (IBS-C)
- Diarrhea predominant (IBS-D)
- Mixed with both constipation and diarrhea (IBS-M)
Pathophysiology of IBS
- IBS is thought to result from dysregulation of the "brain–gut axis"
- Enteric nerves control intestinal smooth muscle action and are connected to the brain by the autonomic nervous system
- Several neurochemicals mediate their function, including serotonin (5-HT), acetylcholine, substance P, and nitric oxide
- Serotonin is particularly important as the GI tract contains the largest amounts in the body
Role of 5-HT in IBS
- Two 5-HT receptor subtypes, 5-HT3 and 5-HT4, are involved in gut motility, visceral sensitivity, and gut secretion
- 5-HT3 receptors slow colonic transit and increase fluid absorption
- 5-HT4 receptor stimulation accelerates colonic transit
Other Factors Contributing to IBS
- Some IBS patients demonstrate sensitivity to common foods such as wheat, beef, soy, and eggs
- Evidence suggests that an immune component may be involved in IBS patients
Treatment of IBS
Agents for Constipation Predominance (IBS-C)
- Bulk producers: psyllium may increase flatulence, while methylcellulose products are less likely to increase gas production
- Osmotic laxatives: polyethylene glycol 3350 (PEG) or PEG 3350 with electrolytes
- Linaclotide relieves abdominal pain, bloating, and constipation associated with IBS-C
- Lubiprostone treats IBS-C, but only in women aged 18 years and older
Agents for Diarrhea Predominance (IBS-D)
- Loperamide inhibits peristalsis and fluid secretion
- Antispasmodics: dicyclomine and hyoscyamine have been used to treat abdominal pain in IBS patients
Antidepressants in IBS
- Tricyclic antidepressants (TCAs) may help abdominal pain in IBS-D
- Selective serotonin-reuptake inhibitors (SSRIs) may be useful in IBS-C
Rifaximin in IBS
- Rifaximin is a semisynthetic antibacterial agent that inhibits bacterial overgrowth, which contributes to bloating
- It should be used with caution in patients with severe hepatic impairment
Clinical Presentation and Diagnosis of IBS
- Diagnosis is based on symptoms, absence of alarm symptoms, and exclusion of organic disease
- Barium enema, sigmoidoscopy, or colonoscopy may be indicated in the presence of red flag symptoms
Treatment Goals and Approach
- Goals of therapy include complete relief of symptoms and improving quality of life
- Treatment is based on the predominant symptoms of the patient
- For constipation-predominant symptoms (IBS-C), increased dietary fiber is considered first-line therapy
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Description
Assess your knowledge of Irritable Bowel Syndrome (IBS), a functional bowel disorder characterized by recurrent abdominal pain and changes in bowel habits.
