Irritable Bowel Syndrome (IBS) - Diagnosis and Management Summary
Diagnosis:
 • Use a positive diagnostic strategy with minimal testing.  IBS is NOT a diagnosis of exclusion.
 • Rome IV Criteria - Recurrent abdominal pain ~ ≥ 1x/ week in last 3 months + symptom onset ≥ 6 months associated with ≥ 2 of the following:
    1. Related to defecation
    2. Change in frequency of stool
    3. Change in form of stool
    * Bloating not required for diagnosis
Treatment:
 • Global IBS Symptoms:
    - Limited trial low FODMAP diet
    - Soluble, viscous, poorly fermentable fiber
    - Peppermint oil (Menthe piperita)
    - Tricyclic Antidepressants
    - Gut-directed psychotherapies
 • IBS-D:
    - Rifaximin- up to 3 courses
    - Alosetron 0.5-1 mg BID in ♀ with severe symptoms who failed conventional tx
    - Mixed opioid agonists/antagonists (eluxadoline 75-100mg QD)
 • IBS-C:
    - Secretagogues → activate receptors on apical membranes of intestinal epithelial cells intestinal secretion & peristalsis
    - 5-HT4 (Serotonin) agonist tegaserod 6mg BID in ♀ <65yo with 1 cardiovascular risk factors who failed secretagogues

by Tina Hang, MD @TinaPhamHang via Emory Gastroenterology and Hepatology @EmoryGastroHep

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