Thread by @john_damianosMD

🚨New @AmCollegeGastro guidelines for the treatment of irritable bowel syndrome! I will summarize in this🧵 ⬇️⬇️⬇️

journals.lww.com/ajg/Abstract/9…

Authors: #BrianLacy, @MarkPimentelMD, @dbrennerGIMD, @umfoodoc, @drlauriekeefer, @MLongMD, @BMoshiree

#GITwitter #GI #IBS #gut #MedEd

🔘In pts w diarrhea, rule out #celiac disease🍞
🔘In pts w diarrhea + no🚨features, check fecal calprotectin/fecal leukocytes AND CRP to rule out #IBD
🔘❌routine 💩testing for enteric pathogens in #IBS
🔘❌colonoscopy in IBS if <45 and no🚨s
🔘Make POSITIVE IBS dx (Rome), ❌DOE

🔘Identify #IBS subtype to target therapy
🔘❌testing for food allergies/sensitivities
🔘Test anorectal physiology in pts w IBS + symptoms suggestive of pelvic floor disorder +/or refractory #constipatoin
🔘Limited trial of low-#FODMAP #diet
🔘✅soluble fiber,❌insoluble fiber

🔘❌antispasmodics for #IBS
🔘✅peppermint🌿
🔘❌#probiotics
🔘❌PEG in IBS-C
🔘✅chloride channel activators in IBS-C
🔘✅guanylate cyclase activators in IBS-C
🔘✅5-HT4 agonist tegaserod in👩IBS-C
<65 yo w≤1 🫀RF who have❌responded to secretagogues

🔘❌bile acid sequestrants for #IBS-D
🔘✅rifaximin for IBS-D
🔘✅alosetron in👩w severe IBS-D who have failed other therapies
🔘✅mixed opioid agonists/antagonists (eluxadoline) for IBS-D
🔘✅tricyclic antidepressants
🔘#gut-directed psychotherapies
🔘❌#FMT

That's all, folks! Cheers to #guthealth!

#GI #GITwitter #gut #medicine #science #IBS #MedEd

@JCPetrov