🧑⚕️-😷
Doctor-patient communication
🧑⚕️A strong 🧑⚕️-😷 relationship is fundamental to the management of #IBS
😷Patients want their 🧑⚕️ to ⬆️empathy, support and information about the nature of IBS, diagnosis, and treatment options
DIAGNOSIS
🩸New pt: CBC, CRP or ESR, celiac serology and, if <45 w diarrhea, fecal calprotectin
➕Make POSITIVE diagnosis based on @RomeFoundation criteria
➡️Refer to #GI when: diagnostic doubt, pt w symptoms that are severe or refractory to 1stline tx,or when pt wants specialist
DIAGNOSIS
❌Colonoscopy unless🚩features OR #IBS-D with atypical features that may suggest microscopic colitis (female,≥50, autoimmune disease,nocturnal or severe, watery diarrhea, duration of 💩 <12 months, weight loss or use of potential precipitating 💊 inclu NSAIDs & PPIs
DIAGNOSIS
💩If atypical feature (as above) or a prior cholecystectomy, consider 23-seleno-25-homotaurocholic acid scanning or serum 7α-hydroxy-4-cholesten-3-one to exclude bile acid diarrhea (#BAD)
😢Not in U.S.A. 🇺🇸
DIAGNOSIS
🚽If coexisting signs of defecatory disorder or fecal incontinence, consider anorectal physiology tests (to assess if biofeedback warranted)
❌testing for exocrine pancreatic insufficiency
❌breath testing for #SIBO
❌testing for carbohydrate intolerance
DIAGNOSIS
🧑🎓NAME the diagnosis #IBS
🧑🎓Explain as a DISORDER OF GUT-BRAIN INTERACTION
🧑🎓Explain how diet, stress, cognitive, behavioral, emotional responses to symptoms, and infections can contribute to brain-gut dysfunction
TREATMENT
🚴♀️Exercise
❌IgG elimination diet
🍞⬆️Soluble fiber (eg ispaghula), watch out for insoluble fiber (eg wheat bran) which can ⬆️symptoms
🥦⬇️FODMAP diet is 2nd line, in conjunction w RD, and with gradual reintroduction of foods
❌Gluten free
💊✅#probiotics but❓strain
TREATMENT
💊✅loperamide for diarrhea, but may ⬆️abdominal pain, bloating, nausea, & constipation, so start lo and go slow
💊✅certain antispasmodics, but may⬆️dry mouth, visual disturbance, & dizziness
💊✅peppermint oil, but may⬆️#GERD
💊✅PEG for #constipation, but may⬆️pain
2nd line TREATMENT
💊EXPLAIN why we use neuromodulators
💊✅TCAs
💊✅SSRIs
💊✅Eluxadoline for #IBS-D (❌in sphincter of Oddi d/o, cholecystectomy, alcohol dependence, pancreatitis, severe liver impairment)
💊✅Serotonin modulators alosetron and ramosetron or ondansetron IBS-D
Postlude on #probiotics:
Signals found for
🦠combination probiotics
🦠Lactobacilli
🦠Bifidobacteria
🦠Escherichia
"Variations in study design, strain&species of probiotic used&heterogeneity btw studies make it difficult to give specific recommendations. However, it is reasonable to advise pts...to take...for up to 12 weeks, & to discontinue treatment if there is no improvement in symptoms."
That's all, folks! What do you think of these #IBS guidelines?
A little late but better late than never! ⌚️ Here's a recap of @AmCollegeGastro Virtual Grand Rounds by @ScottGabbardMD on...... FUNCTIONAL DYSPEPSIA!
🤢🤢🤢
This is a VERY common entity that is underdiagnosed! #MedTwitter take notice!
DYSPEPSIA = epigastric #pain. (can be associated with any other upper #GI symptom such as epigastric fullness, nausea, vomiting, or heartburn).
Dyspepsia is COMMON, and most cases are FUNCTIONAL (i.e., caused by brain-gut axis dysfunction)!
Like all disorders of gut-brain interactions FD pathophysiology is❌completely understood, but is thought to be complex+multifactorial. Components include
🤢disrupted duodenal barrier
🤢altered duodenal #microbiome
🤢dysmotility
🤢visceral hypersensitivity
🤢psychosocial stress
🔘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
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!