Irritable Bowel Syndrome with Diarrhea

Differential Diagnosis ◽

Abdominal Pain ◽

Treatment Options ◽

Clinical Manifestations ◽

Signs And Symptoms ◽

Treatment Modalities ◽

Dietary Advice ◽

Emerging Therapies ◽

Irritable bowel syndrome (IBS) is a complex, functional gastrointestinal condition characterized by abdominal pain and alteration in bowel habits without an organic cause. One of the subcategories of this disorder is IBS with diarrhea (IBS-D). Clinically, patients who present with more than 3 months of abdominal pain or discomfort associated with an increase in stool frequency and/or loose stool form are defined as having IBS-D. This review addresses IBS-D, detailing the epidemiology, etiology and genetics, pathophysiology and pathogenesis, diagnosis, clinical manifestations and physical examination findings, differential diagnosis, treatment, emerging therapies, complications, and prognosis. Figures show potential mechanisms and pathophysiology of IBS, IBS-D suspected by clinical assessment and Rome III criteria, pharmacologic and nonpharmacologic treatment options, potential mechanisms of action of probiotics, and potential treatment modalities. Tables list the Rome criteria for IBS, alarm signs and symptoms suggestive of alternative diagnoses, IBS criteria, differential diagnosis of IBS-D, dietary advice options for IBS-D, and alternative and emerging therapies in IBS-D. This review contains 5 figures, 6 tables and 42 references KEYWORDS: IBS-D, eluxadoline, rifaximin, probiotics, bloating, antidepressants, bile acid malabsorption, microscopic colitis, celiac

Irritable Bowel Syndrome with Diarrhea

10.2310/fm.5445 ◽

2018 ◽

Author(s):

Judy Nee ◽

Jacqueline L. Wolf

Keyword(s):

Differential Diagnosis ◽

Abdominal Pain ◽

Treatment Options ◽

Clinical Manifestations ◽

Signs And Symptoms ◽

Treatment Modalities ◽

Dietary Advice ◽

Emerging Therapies ◽

Irritable bowel syndrome (IBS) is a complex, functional gastrointestinal condition characterized by abdominal pain and alteration in bowel habits without an organic cause. One of the subcategories of this disorder is IBS with diarrhea (IBS-D). Clinically, patients who present with more than 3 months of abdominal pain or discomfort associated with an increase in stool frequency and/or loose stool form are defined as having IBS-D. This review addresses IBS-D, detailing the epidemiology, etiology and genetics, pathophysiology and pathogenesis, diagnosis, clinical manifestations and physical examination findings, differential diagnosis, treatment, emerging therapies, complications, and prognosis. Figures show potential mechanisms and pathophysiology of IBS, IBS-D suspected by clinical assessment and Rome III criteria, pharmacologic and nonpharmacologic treatment options, potential mechanisms of action of probiotics, and potential treatment modalities. Tables list the Rome criteria for IBS, alarm signs and symptoms suggestive of alternative diagnoses, IBS criteria, differential diagnosis of IBS-D, dietary advice options for IBS-D, and alternative and emerging therapies in IBS-D. This review contains 5 highly rendered figures, 6 tables, and 99 references.

Irritable Bowel Syndrome with Diarrhea

10.2310/tywc.5445 ◽

2018 ◽

Author(s):

Judy Nee ◽

Jacqueline L. Wolf

Keyword(s):

Differential Diagnosis ◽

Abdominal Pain ◽

Treatment Options ◽

Clinical Manifestations ◽

Signs And Symptoms ◽

Treatment Modalities ◽

Dietary Advice ◽

Emerging Therapies ◽

Irritable bowel syndrome (IBS) is a complex, functional gastrointestinal condition characterized by abdominal pain and alteration in bowel habits without an organic cause. One of the subcategories of this disorder is IBS with diarrhea (IBS-D). Clinically, patients who present with more than 3 months of abdominal pain or discomfort associated with an increase in stool frequency and/or loose stool form are defined as having IBS-D. This review addresses IBS-D, detailing the epidemiology, etiology and genetics, pathophysiology and pathogenesis, diagnosis, clinical manifestations and physical examination findings, differential diagnosis, treatment, emerging therapies, complications, and prognosis. Figures show potential mechanisms and pathophysiology of IBS, IBS-D suspected by clinical assessment and Rome III criteria, pharmacologic and nonpharmacologic treatment options, potential mechanisms of action of probiotics, and potential treatment modalities. Tables list the Rome criteria for IBS, alarm signs and symptoms suggestive of alternative diagnoses, IBS criteria, differential diagnosis of IBS-D, dietary advice options for IBS-D, and alternative and emerging therapies in IBS-D. This review contains 5 highly rendered figures, 6 tables, and 99 references.

Irritable Bowel Syndrome with Constipation

10.2310/gastro.5444 ◽

2015 ◽

Author(s):

Loni Tang ◽

Brooks D. Cash

Keyword(s):

Differential Diagnosis ◽

Abdominal Pain ◽

Digital Rectal Examination ◽

Recurrent Abdominal Pain ◽

Differential Diagnoses ◽

Rectal Examination ◽

Stool Form ◽

Alarm Features ◽

Irritable bowel syndrome (IBS) is characterized by recurrent abdominal pain or discomfort that has occurred at least 3 days per month in the 3 months prior to diagnosis. One of the subtypes of this disorder is IBS with constipation (IBS-C), where individuals experience hard or lumpy stools at least 25% of the time and loose or watery stools less than 25% of the time with defecation. This review addresses IBS-C, detailing the epidemiology, etiology, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, and prognosis. A figure shows the Bristol stool form scale. Tables list IBS subtypes, components of digital rectal examination, differential diagnoses for IBS and IBS-C, alarm features, and the American College of Gastroenterology Recommendations. This review contains 1 highly rendered figure, 6 tables, and 71 references.

Some antispasmodic drugs for the irritable bowel syndrome

Drug and Therapeutics Bulletin ◽

10.1136/dtb.24.24.93 ◽

1986 ◽

Vol 24 (24) ◽

pp. 93-95

Keyword(s):

Abdominal Pain ◽

Intestinal Disease ◽

Bowel Habit ◽

Dietary Advice ◽

Irritable bowel syndrome (IBS) is commonly diagnosed when the typical symptoms of irregular bowel habit, abdominal pain and distension, and a feeling of incomplete defaecation are not associated with other gastro-intestinal disease. The management of the patient with IBS has been covered previously1 but if dietary advice, reassurance and simple psychotherapy have proved unhelpful the doctor may be under pressure to prescribe as symptoms are usually recurrent. We now review the evidence to support the use of some antispasmodic drugs.

Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis

Gut ◽

10.1136/gutjnl-2021-325214 ◽

2021 ◽

pp. gutjnl-2021-325214

Author(s):

Christopher J. Black ◽

Heidi M. Staudacher ◽

Alexander C. Ford

Keyword(s):

Abdominal Pain ◽

Meta Analysis ◽

Tertiary Care ◽

Bowel Habit ◽

Dietary Advice ◽

Abdominal Bloating ◽

Irritable Bowel ◽

Fodmap Diet ◽

The Impact

ObjectiveA diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) is recommended for irritable bowel syndrome (IBS), if general lifestyle and dietary advice fails. However, although the impact of a low FODMAP diet on individual IBS symptoms has been examined in some randomised controlled trials (RCTs), there has been no recent systematic assessment, and individual trials have studied numerous alternative or control interventions, meaning the best comparator is unclear. We performed a network meta-analysis addressing these uncertainties.DesignWe searched the medical literature through to 2 April 2021 to identify RCTs of a low FODMAP diet in IBS. Efficacy was judged using dichotomous assessment of improvement in global IBS symptoms or improvement in individual IBS symptoms, including abdominal pain, abdominal bloating or distension, and bowel habit. Data were pooled using a random effects model, with efficacy reported as pooled relative risks (RRs) with 95% CIs, and interventions ranked according to their P-score.ResultsWe identified 13 eligible RCTs (944 patients). Based on failure to achieve an improvement in global IBS symptoms, a low FODMAP diet ranked first vs habitual diet (RR of symptoms not improving=0.67; 95% CI 0.48 to 0.91, P-score=0.99), and was superior to all other interventions. Low FODMAP diet ranked first for abdominal pain severity, abdominal bloating or distension severity and bowel habit, although for the latter it was not superior to any other intervention. A low FODMAP diet was superior to British Dietetic Association (BDA)/National Institute for Health and Care Excellence (NICE) dietary advice for abdominal bloating or distension (RR=0.72; 95% CI 0.55 to 0.94). BDA/NICE dietary advice was not superior to any other intervention in any analysis.ConclusionIn a network analysis, low FODMAP diet ranked first for all endpoints studied. However, most trials were based in secondary or tertiary care and did not study effects of FODMAP reintroduction and personalisation on symptoms.

Pharmacological Therapies and Their Clinical Targets in Irritable Bowel Syndrome With Diarrhea

Frontiers in Pharmacology ◽

10.3389/fphar.2020.629026 ◽

2021 ◽

Vol 11 ◽

Author(s):

Esther Colomier ◽

Joost Algera ◽

Chloé Melchior

Keyword(s):

Quality Of Life ◽

Abdominal Pain ◽

Pharmacological Treatment ◽

Treatment Options ◽

Treatment Algorithm ◽

Gastrointestinal Symptoms ◽

Bowel Habits ◽

Irritable bowel syndrome (IBS) is one of the most common disorders of the gut-brain axis, which affects approximately 4% of the global population. The Rome IV criteria define IBS as chronic or recurrent abdominal pain associated with altered bowel habits. Patients can be categorized in four subtypes: IBS with predominant constipation (IBS-C), predominant diarrhea (IBS-D), mixed bowel habits (IBS-M), and unclassified (IBS-U). IBS is associated with a lower quality of life, reduced work productivity, and high healthcare costs. When comparing subtypes, patients with IBS-D report lower disease related quality of life. Due to the scope of this review, we have solely focused on patients with IBS-D. Choosing the right pharmacological treatment in these patients remains challenging due to the heterogeneous patient population, patients’ expectation of the treatment outcome, unavailability of efficacious drugs, and the multifactorial and incompletely understood underlying pathophysiology. Currently, pharmacological treatment options target individual symptoms, such as abdominal pain, altered bowel habits, and bloating. In this review, we aimed to summarize the current and recent pharmacological treatment options in IBS-D, targeting the predominant gastrointestinal symptoms. Additionally, we proposed a pharmacological treatment algorithm which healthcare professionals could use when treating individual patients with IBS-D.

Erythromycin Estolate Induced Hepatotoxicity

Drug Intelligence & Clinical Pharmacy ◽

10.1177/106002807701100102 ◽

1977 ◽

Vol 11 (1) ◽

pp. 22-25 ◽

Cited By ~ 11

Author(s):

Larry G. Cacace ◽

Byron F. Schweigert ◽

Andrew M. Gildon

Keyword(s):

Adverse Drug Reaction ◽

Differential Diagnosis ◽

Drug Reaction ◽

Abdominal Pain ◽

Liver Disease ◽

Diagnostic Tests ◽

Liver Toxicity ◽

Clinical Manifestations ◽

Signs And Symptoms ◽

Erythromycin Estolate

A case of erythromycin estolate induced hepatotoxicity is presented and 65 previous cases reported are reviewed. In spite of numerous reports of liver toxicity from erythromycin estolate, this potentially serious adverse drug reaction is not always recognized by the clinician. The frequency of signs and symptoms and a summary of the laboratory test abnormalities has been prepared to assist the clinician in the differential diagnosis of erythromycin estolate-induced liver disease. The most common clinical manifestations of erythromycin estolate-induced liver disease were severe abdominal pain, nausea and fever which preceded the development of jaundice in most cases. Eosinophilia was frequently present. It is important to consider erythromycin estolate as a potential cause of acute abdomen to avoid unnecessary and potentially dangerous diagnostic tests or surgery. When considering the use of erythromycin, the risk of intrahepatic cholestasis and/or abdominal pain should be weighed against any theoretical benefit to be derived from using the estolate salt.