2) Our returning expert faculty is John Damianos MD @john_damianosMD from @MayoClinicGIHep. In this program he explores optimal current assessment and management of #IBS with #constipation, #IBS_C. Follow this 🧵for 0.75hr 🆓CE/#CME! pic.twitter.com/YOB8BAbaoJ
— ibs_ce (@ibs_ce) April 15, 2025
4) So–what do you know?? Let’s see!
38♀️ evaluated for longstanding constipation (w/ considerable straining & incomplete evacuation) & abdominal pain. CBC, inflammatory markers, celiac serology, & CT abdomen are normal. What is the next best step?— ibs_ce (@ibs_ce) April 15, 2025
6) You see a 34♀️ for a 2nd opinion for chronic #constipation & abdominal pain. She carries a diagnosis of #IBS_C but has not responded to osmotic or stimulant laxatives or diet change. You obtain anorectal physiology & transit studies➡️normal. Which is the next best step?
— ibs_ce (@ibs_ce) April 15, 2025
8) In the work-up, be sure to assess for a rectal evacuation disorder, which necessitates pelvic floor physical therapy with biofeedback. Suggestive symptoms: #bloating, #straining, incomplete evacuation, #digitation. See 🔓 https://t.co/xGOQyX3v88
AND https://t.co/Cs6O5sDls5 pic.twitter.com/pvOxaQZYpz— ibs_ce (@ibs_ce) April 15, 2025
10) First line treatment for #constipation is #diet modification, specifically increasing #fiber.
🥝Kiwi has been shown to be very effective and well tolerated! 2 per day keeps the constipation away! See 🔓 https://t.co/c040mLA49p pic.twitter.com/GuOxIftEa5— ibs_ce (@ibs_ce) April 15, 2025
12) ✅ out the grades of evidence for dietary components to ⬇️ #constipation as published in @AmJGastro at 🔓 https://t.co/kTuDb5nQZM pic.twitter.com/jdTJxf0FXw
— ibs_ce (@ibs_ce) April 15, 2025
14) In #IBS_C, #laxatives treat #constipation but not necessarily the sensory component. This is why @AmCollegeGastro recommends AGAINST 🚫osmotic laxatives like #PEG for IBS-C–but note @AmerGastroAssn does recommend. See 🔓 https://t.co/Cv8Ur6S8o8
AND https://t.co/GKHJ7j28Gw pic.twitter.com/FRQOKMi0Xy— ibs_ce (@ibs_ce) April 15, 2025
16) #Linaclotide:
💊activates GC-C receptors➡️chloride & bicarbonate secretion and targets nociception
💊FDA-approved for #IBS_C (290 μg daily) and for chronic idiopathic #constipation (72 μg or 145 μg daily) pic.twitter.com/SlbMZbkvMQ— ibs_ce (@ibs_ce) April 15, 2025
18) #Linaclotide also improves #BLOATING. See https://t.co/IrrTwupGRw pic.twitter.com/dIjpoRq9Oh
— ibs_ce (@ibs_ce) April 15, 2025
20) #Plecanatide
💊activates GC-C receptors➡️chloride & bicarbonate secretion and targets nociception 💊FDA-approved #IBS_C & chronic idiopathic #constipation (3 mg daily)
💊differs from #linaclotide in that it is pH sensitive ➡️ ⬆️affinity for GC receptor in #duodenum pic.twitter.com/iS0fzhwLmV— ibs_ce (@ibs_ce) April 15, 2025
22) #Guideline recommendations for plecanatide in #IBS_C@AmerGastroAssn: conditional@AmCollegeGastro: strong pic.twitter.com/mtO9r1sIQr
— ibs_ce (@ibs_ce) April 15, 2025
24) #Lubiprostone
💊3 RCTs (n=1154)
💊superior to placebo
💊FDA responder endpoint: 27.4%🆚16.9%
💊improved abdominal pain and global symptoms but not spontaneous #BM
💊AE: gastrointestinal (19%)- mainly diarrhea & nausea
See 🔓 https://t.co/1rlzVdNOBN— ibs_ce (@ibs_ce) April 15, 2025
26) #Tenapanor
💊inhibits GI sodium/hydrogen exchanger isoform 3 ➡️blocks Na+ and Phos- absorption ➡️⬆️H2O secretion and targets nociception
💊FDA-approved IBS-C (50 μg twice daily) pic.twitter.com/h0ViosIuPg— ibs_ce (@ibs_ce) April 15, 2025
28) #Guideline recommendations for #tenapanor in #IBS-C@AmerGastroAssn: conditional pic.twitter.com/ij963t4tYZ
— ibs_ce (@ibs_ce) April 15, 2025
30) Summary of #IBS_C #pharmacotherapy pic.twitter.com/bORrSDScNi
— ibs_ce (@ibs_ce) April 15, 2025
32) And that's it! You just earned 0.75 hr 🆓CE/#CME. Claim your certificate right now at https://t.co/l1V2K7IElK and then 🖱️ that "FOLLOW" button for more expert-authored programs on #IBS. Thanks to @john_damianosMD for another 🏆#tweetorial!
— ibs_ce (@ibs_ce) April 15, 2025
