IBS

Identify common medication causes of diarrhea and constipation

What is chronic diarrhea?

Lasts >14 days

What are possible causes of chronic diarrhea?

Infection

IBD

Malabsorption

Tumor

Drug

Factitious

Motility disturbance

How do you treat chronci diarrhea with a diagnosis vs without a diagnosis?

With a diagnosis- Treat the cause

No Diagnosis- Hydration, dicontinue implicated drug, adjust diet, loperamide

What are the prescription anti-diarrhea medications

Diphenoxylate/atropine (Lomotil)

Difenoxin/Atropine (Motofen)

Paregoric (camphorated tincture of opium)

Octreotide (Sandostatin)

What is the atropine for in Lomotil and Motofen

Atropine discourages abuse

What is the issue with Paregoric

Not used much due to abuse potential

What is Octreotide used for

Diarrhea associated with tumors and carcinoid syndrome

What is the treatment algorithm for constipation?

Bulk forming medications for constipation and what ages can they be used for

Methylcellulose (6&up)

Polycarbophil (6&up)

Psyllium (1&up)

Guar gum

When can we expect releif when on bulk forming meds

3 days

Emollients/stool softners

Docusate sodium (throat irritation)

Docusate calcium

Docusate postassium (can be used rectally)

Should we use mineral oil to treat constipation?

NO! Can cause aspiration

Emollient/stool softerns are mainly for….

Prevention of constipation

Osmotic laxatives for constipation

PEG 3350 (2&up)

Magnesium (2&up)- many med timing interactions

Lactulose/sorbitol/glyceirn- Ok for peds

Sodium phosphate - (2&up)

Stimulant laxatives

Bisacodyl- oral, suppository

Senna- oral, liquid

*ages 2 & up for both

Stimulant laxatives side effect

Abdominal cramps

Intestinal Secretagogue

Lubriprostone- take with food to lessen nausea

Linaclotide- adults only, take before first meal of day

Plecanatide - adults only

Opioid antagonsits/PAMORA for constipation

only work for pts on opiods

Methylnaltrexone

Naldemidine

Naloxegol

Alvimopam (hospital only)

IBS-C vs IBS-D Treatment algorithm

How much dietary fiber for IBS-C?

gradually to goal of 25-35 gm

How much bulk fiber for IBS-C

1 tbsp with one meal per day gradually increases- best evidence favors psyllium

Serotonin 4 agonist for IBC

Tegaserod- REMS, heart issues, only for FEMALES

Dietary modifications for IBS-D

Avoid caffeine, alcohol, artificial sweetners

consider lactose intolerance

herbal products may contain senna

Should we use loperamide for IBS-D

It helps with diarrhea but does not address abdominal pain

Rifaximin & Eluxadoline side effects

Rifaximin- Decreases abd pain, improves stool consistency & bloating

Eluxadoline- alcohol increases pancreatitis risk

5HT3 anatagonist for IBS-D

Alosteron- for females with IBS-D for 6 motnh or longer

Antidepressants

TCAs- only for IBSD bc they slow GI transit time

Duloxetine with anxiety and MDD

TCA or SSRI for IBS abdominal pain