Irritable Bowel Syndrome

Question 1

What is IBS?

Answer 1

A pain syndrome with altered bowel habits

Question 2

Signs and symptoms of IBS?

Answer 2

• Abdominal pain relieved by a bowel movement
• Abdominal pain that is less at night
• Abdominal pain with diarrhea alternating with constipation
• **There is NO fever, NO weight loss, NO blood in the stool.

Question 3

Diagnostic Testing of IBS?

Answer 3

All will be normal.
On the CCS, it is recommended that you order:
1) Stool guaiac, stool white cells, culture, ova and parasite exam
2) Colonoscopy
3) Abdominal CT scan

Question 4

Treatment for IBS?

Answer 4

-Best initial therapy: Fiber. Bulking up the stool helps relieve the pain. Fiber gives the
guts a stretch, like sending the colon to yoga class!

-If there is no relief of pain with fiber, then you should add
antispasmodic/anticholinergic agents, such as dicyclomine or hyoscyamine, which
“relax” the bowel.

-If there is no response to the antispasmodic/anticholinergic agents, you should add a
tricyclic antidepressant, such as amitriptyline.

Question 5

Additional therapy for diarrhea-predominant IBS?

Answer 5

• Rifaximin is a nonabsorbed antibiotic with modest effect in diarrhea-predominant IBS.
• Alosetron is a of serotonin inhibitor with modest effect in IBS; needs special permission to use.
• Eluxadoline is a mu-opioid receptor agonist for diarrhea IBS that relieves pain/slows the bowel.
• Probiotics: Unclear. Do not choose.

Question 6

Additional therapy for constipation-predominant IBS?

Answer 6

• Start with FIBER
• Polyethylene glycol (PEG) is a non-absorbed bowel “lubricant.”
• Lubiprostone (chloride channel activator) is used if PEG doesn’t work.
• Linaclotide or plecanatide (guanylate cyclase agonists) is used if PEG doesn’t work.

Question 7

Benefits of using TCA with IBS?

Answer 7

Tricyclic antidepressants help IBS due to anticholinergic properties; they relieve neuropathic pain; and are an antidepressant.

Question 8

Dicyclomine

Answer 8

MOA: Antispasmodic/Anticholinergic. Blocks acetylcholine from binding to muscarinic receptors on smooth muscle.

USES: helps to decrease gut motility. Works on stomach and intestine to relax muscle spasms and cramps associated with IBS.

***Administer after fiber supplements fail to improve sxs of IBS.

Question 9

Dosage and frequency for Dicyclomine (Clinical practice)

Answer 9

10mg Dicyclomine 3X/day

Question 10

Dicycloverine

Answer 10

“Bentyl”

• Same as Dicyclomine in MOA
• Antispasmodic/anticholinergic
• TX of IBS

Question 11

Viberzi- MOA

Answer 11

“Eluxadoline”

• Contains mixed opioid receptors, including mu receptor agonist, a delta receptor antagonist, and a kappa receptor agonist.
• Acts locally in the enteric nervous system, and decreases adverse effects on the central nervous system.

Question 12

Emollient laxatives
“Stool softners” :

MOA, OTC brand names

Answer 12

• Dulcolax, Miralax, Colace,