1. What are the sx of IBS?
    • abdominal pain/discomfort
    • altered bowel habits
    • physical and emotional distress
  2. What are the proposed mechanisms of IBS?
    • Alterations in GI motility
    • Visceral perception
    • Response to intraluminal contents
    • Mucosa-flora interactions
    • Neuroimmune modulation of gut functions
    • Psychosocial stressors may exacerbate severity of IBS sx
  3. What medications are commonly used to relieve IBS abdominal pain?
    • Myorelaxants - none effective in U.S.
    • Opioid agonists - not proven
    • Peppermint oil - not definitive
  4. What medications are used for IBS gas, but don't work?
    • α-galactosidase (Beano)
    • Simethicone
    • Activated charcoal
  5. What antibiotics may be beneficial for IBS bloating?
    • Neomycin
    • Rifaximin
    • Metronidazole
  6. What is the MOA of antibiotics in IBS bloating?
    decreased bacterial overgrowth to decrease volume and production of gas production
  7. What is the MOA of fiber in C-IBS?
    improve stool consistency and decrease colonic transit time
  8. What is the recommended dose of fiber for C-IBS?
  9. What traditional tx for constipation have no use in C-IBS?
    • stool softeners (docusate)
    • emollients (mineral oil)
    • stimulants (bisacodyl, cascara, senna phenolphthalein, ricinoleic acid)
    • osmotic lasatives (glycerin, lactulose, Mg, sodium phosphate, sorbitol)
  10. What traditional tx for constipation may have some benefit in C-IBS?
  11. What is the MOA of lubipristone in C-IBS?
    activation of CLC2 chloride channels, increasing intestinal secretions to increase motility
  12. What type of IBS is lubipristone approved for?
    C-IBS in women > 18yo
  13. What is the MOA of loperimide in D-IBS?
    • decrease intestinal transit (watch high doses - could cause constipation)
    • increase intestinal and ion absorption
    • increase anal tone at rest
    • increase consistency
    • decrease frequency
    • no effect on pain
  14. Wht is the MOA of alosetron (Lotronex) in D-IBS?
    • slows colonic transit time
    • increases fluid absorption
    • increases consistency
    • decreases pain
  15. What type of IBS is alosetron approved for?
    Women w/ severe D-IBS refractory to conventional tx
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