IBS Flashcards
Signs and symptoms of IBS
Chronic abdominal pain with altered bowel habits (diarrhea or constipation), bloating
Rome IV criteria for IBS
Chronic abdominal pain at least 1 day/week in the last 3 months AND AT LEAST 2 OF THE FOLLOWING:
Associated with defecation
Change in stool frequency
Change in form/appearance of stool
Does IBS affect women or men more?
Women <50 years old
Etiologies of IBS
Genetics, motility factors, colonic infections (gastroenteritis), bowel flora overgrowth, psychological stress
Complications: IBS-C
Bristol Stool Chart: >25% of types 1 and 2, <25% of types 6 and 7
Complications: IBS-D
Bristol Stool Chart: >25% of types 6 and 7, <25% of types 1 and 2
Complications: IBS-M
Bristol Stool Chart: >25% of types 1, 2, 6, and 7
IBS treatment goals
Improve stool frequency and consistency, improve global symptoms
Treatment options for IBS-C
Lubiprostone (Amitiza)
Linaclotide (Linzess)
Plecanatide (Trulance)
Tegaserod (Zelnorm)
Lubiprostone is approved for IBS-C in what patients?
WOMEN ONLY
Lubiprostone dosing
8mg BID WITH FOOD
Lubiprostone side effects
Diarrhea and nausea
Secretagogue medications
Linaclotide (Linzess) and plecanatide (Trulance)
Linaclotide dosing
290mcg PO QD
Plecanatide dosing
3mg PO QD
ADE of linaclotide and plecanatide
Diarrhea (Linzess more than Trulance)
5-HT4 agonist drug
Tegaserod (Zelnorm)
When to use secretagogues in IBS-C therapy
FIRST! It’s first-line!
When to use 5-HT4 agonist/tegaserod in IBS-C therapy
Last-line if patients fail to respond to first-line treatment
Tegaserod/Zelnorm dosing
6mg PO BID
Tegaserod ADE
Increased risk of cardiac events
What patients can you use tegaserod/Zelnorm in? (Patient characteristics)
Use in women <65 years old without cardiac history and no more than one risk factor (HTN, smoking, BMI >30, DM, HLD, age >55)
When to stop tegaserod/Zelnorm
No benefit seen in 4-6 weeks
Treatments for IBS-D
Rifaximin, eluxadoline (Vibrezi), alosetron
Rifaximin dosing
550mg PO TID x14 days, can be repeated up to 2 more times in a year
Rifaximin has the greatest effect in what patients?
Patients with SIBO
Eluxadoline (Vibrezi) dosing
100mg PO BID (alternative is 75mg PO BID)
ADE of eluxadoline (Vibrezi)
Sphincter of Oddi dysfunction
Contraindications of eluxadoline
History of pancreatitis, no gallbladder, history or current history of alcoholism, patients who ingest ≥3 alcoholic drinks a day
Eluxadoline (Vibrezi) drug class
Mu agonist, delta antagonist, kappa agonist
Alosetron drug class
5HT-3 antagonist
Alosetron dosing
0.5mg PO BID IN WOMEN ONLY
When to use alosetron in IBS-D treatment
Patients who have failed rifaximin and eluxadoline
Side effects of alosetron
Severe constipation and severe colitis –> REMS PROGRAM!
When to stop alosetron treatment
If there’s no effect within 4 weeks
Treatments for both IBS-D and IBS-C
Tricyclic antidepressants, soluble fiber products, nonpharm care
Tricyclic antidepressants for IBS
Amitriptyline and nortriptyline
Amitriptyline dosing
50-100mg PO
When should you take amitriptyline?
At bedtime due to anticholinergic side effects
Nortriptyline dosing
25-75mg PO
Soluble fiber products
Psyllium, oat bran, barley, beans
Nonpharm care for IBS
Psychotherapy, counseling, relaxation, stress management techniques, hypnosis, cognitive-behavioral treatment
