Irritable Bowel Syndrome: A Review of Treatment Options

Irritable Bowel Syndrome: A Review of Treatment Options

Abstract and Introduction

Abstract

Irritable bowel syndrome (IBS) is a complex gastrointestinal condition whose pathophysiology is not well understood. Nonpharmacologic treatment options are the mainstay of therapy, and interventions should focus on dietary alterations and physical activity initially and throughout treatment. Drug therapy is rather limited but is focused on the predominant symptoms of IBS—constipation or diarrhea—as well as on improving abdominal pain. Pharmacists have a vital role in patient education and in drug-therapy management for IBS, and they can help ensure that treatment is safe and efficacious.

Introduction

Irritable bowel syndrome (IBS) encompasses a group of gastrointestinal (GI) conditions that are characterized by pain and abnormal bowel habits that have no identifiable root cause. The pathophysiology of IBS is not completely understood, but a wide variety of factors are believed to be involved. Data are conflicting and have not revealed a specific abnormality that can elucidate why IBS occurs or point to a particular mode of therapy. Many currently used treatments for IBS have addressed GI motility, visceral and dietary sensitivities, inflammation, and alterations in GI flora. One of the more recent etiologies studied is the role of serotonin in the peristaltic reflex of the gut, where an abnormality could lead to increased or decreased motility.^[1] A 2014 study estimated that 5% to 15% of people worldwide experience IBS symptomatology, making this a disorder that will be encountered often in practice.^[2]

Practice-Changing Highlights From DDW 2018

Practice-Changing Highlights From DDW 2018

Hello. I am Dr David Johnson, professor of medicine and chief of gastroenterology at Eastern Virginia Medical School in Norfolk, Virginia.

I recently returned from attending Digestive Disease Week (DDW) in Washington, DC, and would like to share my takeaway messages from this year's meeting, some of which will affect our practice in the short term and others in the long term.

New Clinical Practice Guidelines, May 2018 Edition

New Clinical Practice Guidelines, May 2018 Edition

Are You Missing Subtle MI Clues on ECGs? Test Your Skills

Are You Missing Subtle MI Clues on ECGs? Test Your Skills

Are You Missing Subtle MI Clues on ECGs? Test Your Skills

Are You Missing Subtle MI Clues on ECGs? Test Your Skills

Acute Pyelonephritis in Adults | NEJM

Acute Pyelonephritis in Adults | NEJM

KEY CLINICAL POINTS

Acute Pyelonephritis

• Acute pyelonephritis has the potential to cause sepsis, septic shock, and death.
• Urine culture is the cardinal confirmatory diagnostic test.
• Imaging is recommended at the time of presentation for patients with sepsis or septic shock, known or suspected urolithiasis, a urine pH of 7.0 or higher, or a new decrease in the glomerular filtration rate to 40 ml per minute or lower. Subsequent imaging is indicated in patients whose condition worsens or does not improve after 24 to 48 hours of therapy.
• The rising prevalence of Escherichia coli resistant to fluoroquinolones and trimethoprim–sulfamethoxazole complicates empirical oral therapy. In patients who receive oral treatment from the outset, depending on the likelihood of resistance, an initial dose of a supplemental, long-acting, parenteral antimicrobial agent (e.g., an aminoglycoside, ceftriaxone, or ertapenem) may be appropriate, and close follow-up is warranted.
• Assessment of illness severity, underlying host status, and the patient’s psychosocial situation and estimation of the likelihood of pathogen resistance to relevant antimicrobial agents are critical in decisions regarding patient disposition and treatment.

Toxic Alcohols | NEJM

Toxic Alcohols | NEJM

Poisonings by the toxic alcohols (methanol, ethylene glycol, isopropanol, diethylene glycol, and propylene glycol) can cause cellular dysfunction and death,1 but symptoms may be nonspecific. Delays in diagnosis increase the risk of irreversible organ damage and death.2 In this review, we discuss the mechanisms of toxicity, methods available for diagnosis, and current recommendations for therapy.