SM_167b: Functional GI Disorders Flashcards
Functional GI disorders (disorders of gut-brain interaction) are ____
Functional GI disorders (disorders of gut-brain interaction) are disorders where motility, intestinal sensitivity, and/or the manner in which signals between the gut and brain are processed is impaired
- No definitive diagnostic study, subjective symptoms
IBS diagnosis is based only on ____
IBS diagnosis is based only on clinical criteria: presence of specific-symptom based criteria in absence of alarm signs / symptoms
There is significant overlap among GI dysmotility and ____
There is significant overlap among GI dysmotility and sensory disorders
Describe classification of functional GI disorders
Classification of functional GI disorders
- Esophageal disorders
- Gastroduodenal disorders
- Bowel disorders
- Centrally mediated disorders of GI pain
- Gallbladder and sphincter of Oddi disorders
- Anorectal disorders
Describe IBS pathogenesis
IBS pathogenesis
- Bile-acid malabsorption
- Post-infection
- Diet
- Alteration in gut microbiome
- Genetics
- SIBO
- Visceral hypersensitivity and motility
Describe IBS diagnostic criteria
IBS diagnostic criteria (Rome IV): recurrent abdominal pain on average ≥ 1 day/week in last 3 months associated with ≥2 of the following
- Pain related to defecation
- Associated with change in stool form
- Associated with change in stool frequency
Criteria fulfilled for the last 3 months with symptom onset ≥6 months prior to diagnosis
IBS subtypes are ____, ____, and ____
IBS subtypes are IBS-C, IBS-D, and IBS-M
- IBS-C: hard / lumpy stools ≥ 25%, loose / water stools < 25%
- IBS-D: loose / water stools ≥ 25%, hard lumpy stools < 25%
- IBS-M: hard/lumpy stools ≥ 25% and loose watery stools ≥ 25%
IBS-C has predominantly ____ stools
IBS-C has predominantly hard / lumpy stools
- Hard / lumpy stools ≥ 25%, loose / water stools < 25%
IBS-D has predominantly ____ stools
IBS-D has predominantly loose / watery stools
- Loose / water stools ≥ 25%, hard lumpy stools < 25%
Describe diagnosis of IBS
IBS diagnosis
Describe diagnostic testing for suspected IBS and no concerning features
Diagnostic testing for suspected IBS and no concerning features
IBS treatment depends on the ____
IBS treatment depends on the type of IBS
____ should NOT be used in IBS-C, and ____ should NOT be used in IBS-D
PEG laxatives should NOT be used in IBS-C, and loperamide should NOT be used in IBS-D
Lupiprostone is used to treat IBS-C due to mecahanism of ____ which leads to ____
Lupiprostone is used to treat IBS-C due to mecahanism of acting on CIC-2 chloride channels which regulate fluid secretion which leads to increase luminal fluid secretion and intestinal transit
Linaclotide is used to treat IBS-C due to mecahanism of ____ which leads to ____
Linaclotide is used to treat IBS-C due to mecahanism of guanylate cyclase activation which leads to increased luminal fluid secretion and intestinal transit
Plecanatide is used to treat IBS-C due to mecahanism of ____ which leads to increased ____
Plecanatide is used to treat IBS-C due to mecahanism of guanylate cyclase activation which leads to increased luminal fluid secretion and intestinal transit
____ and ____ are used to treat IBS-D
Rifaxamin and eluxadoline are used to treat IBS-D
Eluxadoline is used to treat IBS-D due to action as ____, ____, and ____
Eluxadoline is used to treat IBS-D due to action as mu opioid receptor agonist, delta opioid receptor antagonist, and kappa opioid receptor agonist
- Mu opioid receptor: activation reduces pain and gastric propulsion
- Delta opioid receptor: inhibition restores G-protein signaling and reduces mu agonist-related desensization
Most IBS patients report worsening of symptoms after ____
Most IBS patients report worsening of symptoms after meals
- These changes help: small meals, avoiding fat, increasing fiber, and avoiding milk prodcts
____ diets are helpful for global symptoms of IBS
Low FODMAP diets are helpful for global symptoms of IBS
- FODMAP: fermentable oligo-, di-, monosaccharide, and polyols
____ oil with active component ____ is beneficial for global IBS symptoms and abdominal pain but has increased risk of adverse events
Peppermint oil with active component L-menthol is beneficial for global IBS symptoms and abdominal pain but has increased risk of adverse events
____ is a form of psychotherapy that can be helpful for global symptoms of IBS
CBT is a form of psychotherapy that can be helpful for global symptoms of IBS
Positive doctor patient leads to ____ in patients with IBS
Positive doctor patient leads to decreased symptoms of healthcare seeking in patients with IBS
- Therapeutic relationship is key: increases patient satisfaction, increases adherence to treatment, decreases symptoms, results in less patient uncertainty
