IBS

Question 1

Etiology for IBS

Answer 1

brain-gut-axis - emotional expression thru gut 5-HT

Question 2

Sx for IBS

Answer 2

pain / spasms
bloating / fullness
urgency
constipation diarrhea
mucous in stool (but no bleeding)

for more than 6 months

Question 3

Differntial for IBS

Answer 3

inflam bowl D
gluten intol
drug induced
lactose intolerance
colorectal Ca

Question 4

Non Rx Tx for IBS

Answer 4

fiber
reduce fatty food
avoid offending foods

Question 5

What does beano do?

Answer 5

prevent gas formation via beans and long chain CHO

Question 6

What does lactaid do?

Answer 6

helps the break down of sugars
therefore
decrease osmotic force
decrease gas

Question 7

What are the main categories for Rx tx for IBS?

Answer 7

constipation dominant
diarrhea dominant

Question 8

Bulk-forming agents

Answer 8

• psyllium is now recommended for IBS-C
• PEG 3350 has less proof (that will change someday)
• might help with IBS-D too

Question 9

Smooth muscle relaxants

Answer 9

create less spasm/better coordination
work best if used regularly
can work with both IBS-D and IBS-C

Question 10

List some smooth muscle relaxants

Answer 10

pinaverium (dicetel)
Trimebutine (modulon)

Question 11

Imodium

Answer 11

used as anti-diarrheals
decrease D but does not help with pain

Question 12

Diphenoxylate

Answer 12

used for anti-D
more s/e and Rx so less common

Question 13

Laxatives

Answer 13

you can use any form of laxatives to help with IBS-C all based on timeline and situation

Question 14

Peppermint Oil

Answer 14

mildly effective
used as smooth muscle relaxant so can be used either type
enteric caps (SI release)
have low expectations

Question 15

Antidepressants

Answer 15

TCAs can be used for pain and diarrhea
MOA may be the s/e of these agents

SSRIs could be used but not common (more effective and less s/e) used for IBS-C

Question 16

Alosetron

Answer 16

historial
5HT3 receptor antagonists
decrease gut motility

Question 17

Tegaserod

Answer 17

historical
5HT4 partial agonist

Question 18

Linaclotide

Answer 18

treatment for moderate to severe IBS-C
guanylate cyclase C receptor agonist
acts locally in GIT to stimulate fluid secretion, increase colonic transit and reduce abdominal symptoms

Question 19

Lubiprostone

Answer 19

IBS-C
it is used by opioid pt to help with constipation

Question 20

tenapanor

Answer 20

used for IBS-c
can locally to increase bowel movements and decrease in abdominal pain
blcoks NH3 (Na/H exchange)

Question 21

Eluxadolin

Answer 21

helps with IBS-D
works on mu-opioid receptor

Question 22

Probiotics

Answer 22

they are a great idea just don’t know enough to choose the right one more of a shot in the dark
could help

Question 23

Anti-cholinergics

Answer 23

not first line (not labeled for IBS)
but could work
less effective then other with more s/e

Question 24

Rifaximin

Answer 24

IBS-D
acts by reducing GI bacterial load

Question 25

What to focus on when talking about IBS?

Answer 25

mainly a focus on laxatives and Imodium
most are likely quite familiar with both
a few will ask about probiotics