Recapping @AmCollegeGastro's #VirtualGrandRounds on #IBS! Let's begin!
🟣IBS can be diagnosed with the Rome criteria
🟣Making a positive diagnosis is very helpful to patients, many of whom have gone years without a name for their symptoms
#IBS is heterogeneous, and so are its pathogenesis and pathophysiology.
🟣Identifying underlying factors in patients can help target treatment!
@AmCollegeGastro
Important principles when diagnosing and treating #IBS.
@AmCollegeGastro
Excess and unnecessary testing is often performed in #IBS, to the detriment of patient and provider. A more rational approach to testing:
@AmCollegeGastro
Lifestyle modification is first-line in the treatment of #IBS.
🟣Reduction of stress (therapy, meditation, #hypnosis, #yoga)
🟣#exercise
🟣#sleep hygiene
🟣eliminate alcohol and #smoking
🟣#diet (best done in conjunction w RD)
@AmCollegeGastro
Dietary management of #IBS
🟣low-FODMAP diet has the most data for improving symptoms
🤢FODMAPS⬆️IBS symptoms from gas production in pts w visceral hypersensitivity
🟣#gluten-free helps some IBS-D patients, but they may actually have non-celiac gluten sensitivity
@AmCollegeGastro
Both low-FODMAP and mNICE diets have data for improving #IBS symptoms.
@AmCollegeGastro
Pharmacologic treatment of #IBS should be driven by the most distressing symptom.
OTC options include:
🟣antidiarrheals: loperamide, clay binders
🟣anti-spasmodics
🟣peppermint oil
🟣#probiotics
@AmCollegeGastro
Many agents commonly used in #IBS do not have much good evidence!
@AmCollegeGastro
Peppermint oil has some data for #pain in #IBS. Enteric coated is best to avoid exacerbation of #GERD.
🟣NNT=4!
@AmCollegeGastro
#Probiotics have some data for #IBS, but the strain is important. [Side note: head over to @aeprobio for evidence-based recommendations!]
🟣NNT=7 (class effect, likely larger with appropriate strain specificity)
@AmCollegeGastro
FDA approved therapies for #IBS-D:
🟣rifaximin
🟣euladoxine
🟣alosetron
@AmCollegeGastro
The efficacy of rifaximin in #IBS-D was demonstrated in TARGET 1-3.
@AmCollegeGastro
Evidence for euladoxine in #IBS-D.
@AmCollegeGastro
Data for alosetron in #IBS-D.
@AmCollegeGastro
Antidepressants/neuromodulators have good data for #IBS, with TCAs having the strongest data. Use side effects to your advantage!
@AmCollegeGastro
Bulking agents are recommended in #IBS-C, but the evidence is weak.
@AmCollegeGastro
FDA approved therapies for #IBS-C.
🟣linaclotide
🟣plecanatide
🟣lubiprostone
🟣tegaserod
🟣tenapanor
@AmCollegeGastro
Evidence of linaclotide for #IBS-C.
@AmCollegeGastro
Evidence for plecanatide, lubiprostone, tegaserod, and tenapanor in #IBS-C.
@AmCollegeGastro
No increased risk of MACE with tegaserod as previously thought.
@AmCollegeGastro
Reached the thread limit- see next tweet for the rest!!!
@AmCollegeGastro #virtualgrandrounds #IBS #GITwitter #GI #gut #microbiome #FGID #DBGI #motility
Research into therapies for #IBS is rapidly expanding. Here are some of the candidate agents and pathways ⬇️⬇️⬇️
@AmCollegeGastro
Bile acid malabsorption is very common in #IBS-D. Bile acid sequestrants are a potential therapy to treat the diarrhea.
@AmCollegeGastro #motility
Ramosetron is a serotonergic agent that has decent preliminary data in #IBS.
@AmCollegeGastro
Mast cell dysregulation may play a role in diarrhea and visceral hypersensitivity in some #IBS patients.
@AmCollegeGastro
Agents that target TRPV channels are being investigated for #IBS. (TPRV is also the mechanism for the efficacy of heat and capsaicin in cyclic vomiting syndrome!)
@AmCollegeGastro
Human milk oligosaccharides modulate the #microbiome, which may be beneficial for the dysbiosis in #IBS.
@AmCollegeGastro
#FMT has had conflicting data for #IBS.
@AmCollegeGastro
Multiple devices are being investigated for #IBS, such as this vibrating capsule!
@AmCollegeGastro
🔑 point from @AmCollegeGastro's #VirtualGrandRounds on management of #IBS.
My thoughts:
🟣NAME the diagnosis!
🟣lifestyle changes first
🟣treat most distressing symptom
🟣use evidence-based rx/OTC
🟣the fewer 💊💊💊, the better
🟣the future of IBS therapies is exciting! 🔥
From @RomeFoundation @RomeGastroPsych regarding neuromodulators.
And I like to use @UpToDate's table on antidepressant side effects to help guide therapy.
Share this Scrolly Tale with your friends.
A Scrolly Tale is a new way to read Twitter threads with a more visually immersive experience.
Discover more beautiful Scrolly Tales like this.