SM_167b: Functional GI Disorders

Question 1

Functional GI disorders (disorders of gut-brain interaction) are ____

Answer 1

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

Question 2

IBS diagnosis is based only on ____

Answer 2

IBS diagnosis is based only on clinical criteria: presence of specific-symptom based criteria in absence of alarm signs / symptoms

Question 3

There is significant overlap among GI dysmotility and ____

Answer 3

There is significant overlap among GI dysmotility and sensory disorders

Question 4

Describe classification of functional GI disorders

Answer 4

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

Question 5

Describe IBS pathogenesis

Answer 5

IBS pathogenesis

• Bile-acid malabsorption
• Post-infection
• Diet
• Alteration in gut microbiome
• Genetics
• SIBO
• Visceral hypersensitivity and motility

Question 6

Describe IBS diagnostic criteria

Answer 6

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

Question 7

IBS subtypes are ____, ____, and ____

Answer 7

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%

Question 8

IBS-C has predominantly ____ stools

Answer 8

IBS-C has predominantly hard / lumpy stools

• Hard / lumpy stools ≥ 25%, loose / water stools < 25%

Question 9

IBS-D has predominantly ____ stools

Answer 9

IBS-D has predominantly loose / watery stools

• Loose / water stools ≥ 25%, hard lumpy stools < 25%

Question 10

Describe diagnosis of IBS

Answer 10

IBS diagnosis

Question 11

Describe diagnostic testing for suspected IBS and no concerning features

Answer 11

Diagnostic testing for suspected IBS and no concerning features

Question 12

IBS treatment depends on the ____

Answer 12

IBS treatment depends on the type of IBS

Question 13

____ should NOT be used in IBS-C, and ____ should NOT be used in IBS-D

Answer 13

PEG laxatives should NOT be used in IBS-C, and loperamide should NOT be used in IBS-D

Question 14

Lupiprostone is used to treat IBS-C due to mecahanism of ____ which leads to ____

Answer 14

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

Question 15

Linaclotide is used to treat IBS-C due to mecahanism of ____ which leads to ____

Answer 15

Linaclotide is used to treat IBS-C due to mecahanism of guanylate cyclase activation which leads to increased luminal fluid secretion and intestinal transit

Question 16

Plecanatide is used to treat IBS-C due to mecahanism of ____ which leads to increased ____

Answer 16

Plecanatide is used to treat IBS-C due to mecahanism of guanylate cyclase activation which leads to increased luminal fluid secretion and intestinal transit

Question 17

____ and ____ are used to treat IBS-D

Answer 17

Rifaxamin and eluxadoline are used to treat IBS-D

Question 18

Eluxadoline is used to treat IBS-D due to action as ____, ____, and ____

Answer 18

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

Question 19

Most IBS patients report worsening of symptoms after ____

Answer 19

Most IBS patients report worsening of symptoms after meals

• These changes help: small meals, avoiding fat, increasing fiber, and avoiding milk prodcts

Question 20

____ diets are helpful for global symptoms of IBS

Answer 20

Low FODMAP diets are helpful for global symptoms of IBS

• FODMAP: fermentable oligo-, di-, monosaccharide, and polyols

Question 21

____ oil with active component ____ is beneficial for global IBS symptoms and abdominal pain but has increased risk of adverse events

Answer 21

Peppermint oil with active component L-menthol is beneficial for global IBS symptoms and abdominal pain but has increased risk of adverse events

Question 22

____ is a form of psychotherapy that can be helpful for global symptoms of IBS

Answer 22

CBT is a form of psychotherapy that can be helpful for global symptoms of IBS

Question 23

Positive doctor patient leads to ____ in patients with IBS

Answer 23

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