Irritable Bowel Syndrome (IBS) - Diagnosis and Management Summary
Diagnosis:
• Use a positive diagnostic strategy with minimal testing. IBS is NOT a diagnosis of exclusion.
• Rome IV Criteria - Recurrent abdominal pain ~ ≥ 1x/ week in last 3 months + symptom onset ≥ 6 months associated with ≥ 2 of the following:
1. Related to defecation
2. Change in frequency of stool
3. Change in form of stool
* Bloating not required for diagnosis
Treatment:
• Global IBS Symptoms:
- Limited trial low FODMAP diet
- Soluble, viscous, poorly fermentable fiber
- Peppermint oil (Menthe piperita)
- Tricyclic Antidepressants
- Gut-directed psychotherapies
• IBS-D:
- Rifaximin- up to 3 courses
- Alosetron 0.5-1 mg BID in ♀ with severe symptoms who failed conventional tx
- Mixed opioid agonists/antagonists (eluxadoline 75-100mg QD)
• IBS-C:
- Secretagogues → activate receptors on apical membranes of intestinal epithelial cells intestinal secretion & peristalsis
- 5-HT4 (Serotonin) agonist tegaserod 6mg BID in ♀ <65yo with 1 cardiovascular risk factors who failed secretagogues
by Tina Hang, MD @TinaPhamHang via Emory Gastroenterology and Hepatology @EmoryGastroHep
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