167b - Functional GI Disorders

Question 1

What additional studies are necessary if a patinet meets criteria for IBS-d?

Answer 1

• Rule out celiac
  
  • IgA TtG + total IgA
• Rule out IBD
  
  • Fecal calprotectin
    
    • <40 = most likely NOT IBD

Question 2

Is irritable bowel syndrome a diagnosis of exclusion?

Answer 2

No

Question 3

What diet may help IBS?

Answer 3

Low FODMAP

Question 4

List 2 medications that can be used to treat IBS-d

List 2 medications that can be used to treat IBS-c

Answer 4

IBS-D (with diarrhea)

• Rifaximin (antibiotic)
• Elaxudoline (Mu opiod agonist, delta opioid antagonist)
  
  • Slows gut motility
  • Decreases fluid secretion/increases absorption
  • Decreased pain

IBS-C (with constipation)

• Lubiprostone (Cl- Channels regulate fluid secretion)
• Linaclotide/Plecanatide (Guanylate Cyclase-C activation)

Both increase luminal fluid secretion (with Cl- excretion)

Question 5

What non-pharmacologic treatments may help IBS?

Answer 5

• Peppermint oil
• CBT
  
  • NOT to treat anxiety/depression
  • Goal is to improve gut/brain interaction

Question 6

Based on Rome IV, what is the most essential criteria for diagnosing IBS?

Answer 6

Abdominal pain

ROME IV criteria:

• Recurrent abd pain (or discomfort) on average at least 1 day/week in the last 3 months with 2+ of:
  
  • Pain related to defecation
  • Change in stool form
  • Change in stool frequency

Question 7

List 3 medications that can be used to treat IBS-c

Answer 7

• Lubiprostone (Activates CIC-2 Cl- channels)
• Linaclotide (increases cGMP)
• Plecanatide (increases cGMP)

All cause secretionof fluid into intestinal lumen -> improve stool texture

Question 8

What additional studies are necessary if a patinet meets criteria for IBS-c?

Answer 8

None!