IBS (Exam 2) Flashcards
Rome IV Diagnostic Criteria for IBS
Recurrent pain/discomfort at least 3 days/month in last 3 months with two+ :
1. Relieved with defecation
2. Onset with change in stool frequency
3. Onset with change in appearance of stool
Additional testing
Fecal lactoferrin/calprotectin and C-reactive protein
Serologic testing
FODMAP Diet
Fermentable
Oligosaccharides
Disaccharides
Monosaccharides
Polyols
First line constipation predominant IBS
Increase dietary fiber and fluid intake
Dietary fibers
Fruits
Vegetables
Whole grains
Supplements: Benefiber
Second line constipation predominant IBS
Add bulk-forming laxatives
Alternative second line constipation predominant IBS
Polyethylene gylcol (PEG) 3350
Third line constipation predominant IBS
Lubiprostone
Plecanatide
Linaclotide
Nonpharmacological diarrhea predominant IBS
Avoid diarrhea-inducing foods & drugs
Foods to avoid for IBS
Caffeine
Alcohol
Artificial sweeteners
Lactose
High fiber, greasy, spicy
First line diarrhea predominant IBS
loperamide (Imodium)
Black Box Warning for loperamide (Imodium)
Torsades, cardiac arrest, sudden death
Moderate symptom treatment for diarrhea predominant IBS
Eluxadoline
Rifaximin
Eluxadoline (Viberzi) contraindications
Drink > 3 alcohol/day
No gallbladder
Eluxadoline (Viberzi)
improves abdominal pain and stool consistency
Rifaximin (Xifaxan)
Improves abdominal pain, stool consistency, and bloating
Rifaximin (Xifaxan) can be
repeated twice (6 weeks total)
Second line diarrhea predominant IBS
Add alosetron (Lotronex)
alosetron (Lotronex) is only indicated for
women with IBS-D symptoms
higher serum concentrations in females vs. males
Anti-spasmodic agents: 1st line
short term only
Dicyclomine
Hyoscyamine (SR)
