GASTROENTEROLOGY ARTICLE OF THE WEEK

MARCH 15, 2001

 Camilleri M.  Management of the irritable bowel syndrome.  Gastroenterology 2001;120:652-668.

 Mechanisms that may play a role in the symptoms of IBS include

            a.  a history of prior acute gastroenteritis

            b.  folate deficiency

            c.  carbohydrate intolerance

            d.  food allergy

            e.  serotonin deficiency

            f.  increased ileal sensitivity to bile acids 

A recently diagnosed 38 y/o patient who meets clinical criteria for constipation-predominant IBS and who has no “alarm” symptoms should:

            a.  undergo barium enema or colonoscopy evaluation

            b.  increase fiber intake

            c.  undergo sitzmarker studies of colon transit

            d.  undergo a complete physical exam including digital rectal examination

            e.  be treated with dulcolax bid

 Psychotropic agents in the treatment of IBS are best used in:

            a.  constipation predominant IBS

            b.  diarrhea and pain-predominant IBS

            c.  crazy people

            e.  patients who respond to sessions with Shaman’s healers

            d.  only TCA’s work, SSRI’s have not been shown to be effective

 True or False

 The best initial therapy for Pain/gas/bloat type IBS is the use of charcoal coated simethicone tablets

 Patients over age 40 with IBS should undergo a complete colonic evaluation when presenting with IBS symptoms, even in the absence of a family hx. Of colonic neoplasia.

The antispasmodic agents commonly prescribed in the U.S. have not been found to be effective in treating IBS

 Constipation-predominant IBS patients should consume at least 20-30gm of fiber per day, the efficacy of fiber supplementation in this group is questionable.

 The author of this paper does not seem to be aware of the fact that cholestyramine now is available in a pill form

 Loperamide (Imodium) in contrast to diphenoxylate (Lomotil):       

            a.  increases anal sphincter tone

            b.  contains atropine

            c.  does not traverse the blood brain barrier

            d. reduces post-prandial urgency

Get The Article

Go Back