GASTROENTEROLOGY LITERATURE REVIEW
August 9, 2001
Horwitz BJ, Fisher RS, et al. The Irritable Bowel Syndrome. N Engl J Med 2001;344:1846-1850.
1. Agents most likely to be effective in patients with pain-predominant IBS include
a. loperamide
b. anticholinergic agents
c. fiber supplements
d. lactulose
e. low dose tricyclic anti-depressants
f. nitrates
2. Epidemiologic features of IBS include
a. association with interstitial cystitis and fibromyalgia
b. over 60% of patients with IBS symptoms seek medical care
c. patients with IBS symptoms seeking medical care for IBS are more likely to
have behavioral and psychiatric problems.
d. it is five times more common in females than males.
3. Which of the following pathophysiologic mechanisms is/are accepted as the cause of IBS
a. altered bowel motility with irregular small bowel motor activity
b. visceral hypersensitivity with low pain threshold for visceral distention
c. psychosocial disorders such as somatization, depression and anxiety
d. altered serotonin balance
e. prior enteric infection
f. none of the above
True or False
4. A trial of selective COX-2 inhibitor therapy may be considered in patients with pain-predominant IBS who are not responsive to other measures
5. Antispasmodic agents may help decrease bloating.
6. 5-HT3 receptor antagonists are useful in treating diarrhea-predominant IBS
7. 5-HT4 receptor agonists may be effective in treating constipation-predominant IBS
8. Kappa-opioid agonists may be effective in IBS by decreasing intestinal secretion.
9. Opioid analogues are a useful second-line alternative for patients with pain-predominant IBS
10. A short course of antibiotics may be used in patients with severe diarrhea-predominant IBS who have failed other therapies.
11. IBS requires the presence for 12 weeks or longer of at least 2 of which of the following symptoms:
a. nausea without vomiting
b. pain relieved with defecation
c. pain coinciding with the development of pellet-like stools
d. epigastric pain
e. pain associated with a change in frequency or character of the stool
12. The initial evaluation of a patient with suspected IBS should include:
a. referral to a psychiatrist
b. CBC, blood chemistries and liver tests, TSH
c. anti-HCV, HBsAG and iron studies
d. colonoscopy
e. biopsy during sigmoidoscopy in patients with diarrhea-predominant IBS
13. Symptoms that would trigger additional evaluation (alarm symptoms) include
a. anemia, hematochezia or heme positive stools
b. severe constipation with fecal impaction or severe diarrhea resulting in
dehydration
c. onset of symptoms at age 50 or later
d. weight gain
e. type of medical insurance
14. When managing IBS patients
a. establishing a good doctor-patient relationship is the most important therapeutic strategy
b. dietary triggers of symptoms often include caffeine, alcohol, fatty foods and gas-producing vegetables
c. fiber supplement (20-30g/d) may be useful for treating constipation and may help diarrhea
d. sorbitol or lactulose are good alternatives for the treatment of constipation in IBS