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What are the sx of IBS?
- abdominal pain/discomfort
- altered bowel habits
- physical and emotional distress
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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
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What medications are commonly used to relieve IBS abdominal pain?
- Myorelaxants - none effective in U.S.
- Opioid agonists - not proven
- Peppermint oil - not definitive
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What medications are used for IBS gas, but don't work?
- α-galactosidase (Beano)
- Simethicone
- Activated charcoal
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What antibiotics may be beneficial for IBS bloating?
- Neomycin
- Rifaximin
- Metronidazole
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What is the MOA of antibiotics in IBS bloating?
decreased bacterial overgrowth to decrease volume and production of gas production
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What is the MOA of fiber in C-IBS?
improve stool consistency and decrease colonic transit time
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What is the recommended dose of fiber for C-IBS?
20-25g/d
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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)
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What traditional tx for constipation may have some benefit in C-IBS?
PEG
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What is the MOA of lubipristone in C-IBS?
activation of CLC2 chloride channels, increasing intestinal secretions to increase motility
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What type of IBS is lubipristone approved for?
C-IBS in women > 18yo
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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
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Wht is the MOA of alosetron (Lotronex) in D-IBS?
- slows colonic transit time
- increases fluid absorption
- increases consistency
- decreases pain
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What type of IBS is alosetron approved for?
Women w/ severe D-IBS refractory to conventional tx
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