2) We welcome expert faculty Gregory Brennan MD @GBrennanMD, a #gastroenterologist from Dallas TX, core faculty in the @UNTsocial IntMed residency. In this program he explores optimal current management of #IBS with #diarrhea, #IBS_D. Follow this 🧵for 0.75hr 🆓CE/#CME! pic.twitter.com/41NRyWmFvu
— ibs_ce (@ibs_ce) April 22, 2025
4) So–what do you know?? Let’s see! All the following medications are @US_FDA approved for treatment of #IBS_D EXCEPT:
— ibs_ce (@ibs_ce) April 22, 2025
5b) Physical exam unremarkable. Basic labs CBC, CRP, TSH, & celiac serologies are WNL. A #colonoscopy done 6 months ago was normal. Based on #Rome_IV criteria, she is diagnosed with #IBS_D. She has tried dietary modifications & loperamide with only minimal relief.
— ibs_ce (@ibs_ce) April 22, 2025
6) So let’s get to it!
It is estimated at 15-30 million Americans have #IBS, approximately 5-10% of the population. This is about 10x more common than inflammatory bowel diseases #IBD!— ibs_ce (@ibs_ce) April 22, 2025
8) Let’s review the available therapies for patients with #IBS-Diarrhea #IBS_D.
Check out 🔓 https://t.co/xdWx1ivTPN, authored by @BMoshiree et al. pic.twitter.com/heevcRuMuv— ibs_ce (@ibs_ce) April 22, 2025
9b) That said, the anticholinergic side effects of #TCAs (like amitriptyline) may be beneficial for some patients with #IBS_D.
In addition, #neuromodulators can play a significant role in the treatment of #IBS.— ibs_ce (@ibs_ce) April 22, 2025
11) #RXM has been shown to be effective in trials of tx naive &in those getting re-tx. TARGET 1 & TARGET 2 were identical RCTs comparing RXM 550 mg TID x14d to placebo.
RXM improved:
· Global IBS symptoms
· Bloating
· Abdominal pain
· Diarrhea
See 🔓 https://t.co/LpgNhiPLIZ pic.twitter.com/rzHOZUGNhb— ibs_ce (@ibs_ce) April 22, 2025
13) #Rifaximin #RXM Summary: favorable safety profile, can be used up to three times for treatment.
Dosage: 550 mg TID for 14 days pic.twitter.com/dF0LLEWrxV— ibs_ce (@ibs_ce) April 22, 2025
14b) #Eluxadoline
· Indicated for #IBS_D patients (at low risk of drug side effects)
· May be effective for patients failing #loperamide
· Understand specific contraindications!
See 🔓 https://t.co/Q6fn4xDE8I AND 🔓 https://t.co/BdoxXv8NxV pic.twitter.com/BxW7rs4BAA— ibs_ce (@ibs_ce) April 22, 2025
15b) ANSWER: A history of #cholecystectomy. Why?? #Pancreatitis was one of the most common serious #AEs in trials & all these events happened in pts without a gallbladder.
See Table below for important contraindications:
🔓 https://t.co/Q6fn4xDE8I
🔓 https://t.co/BdoxXv8NxV pic.twitter.com/ZqLKvIalUI— ibs_ce (@ibs_ce) April 22, 2025
17a) #Alosetron:
· approved for relieving global symptoms in ♀️with severe #IBS_D when other interventions have failed.
· #Serotonin (5-hydroxytryptamine; 5-HT) antagonist.
· The primary MOA of alosetron in the treatment of IBS-D is the slowing of intestinal transit— ibs_ce (@ibs_ce) April 22, 2025
19) In 2021, the ACG @AmCollegeGastro published guidelines on the management of #IBS.
Here are the specific recommendations relevant for #IBS_D patients:
🔓https://t.co/IF1MvROAOd pic.twitter.com/1EhsvPYvae— ibs_ce (@ibs_ce) April 22, 2025
21) Dr Brennan’s @GBrennanMD Summary: #IBS_D @US_FDA approved medications pic.twitter.com/HPAN4BJQCD
— ibs_ce (@ibs_ce) April 22, 2025
23) And that's it! You just earned 0.75 hr 🆓CE/#CME. Claim your certificate right now at https://t.co/rnUI3rpSHz and then 🖱️ that "FOLLOW" button for more expert-authored programs on #IBS. Thanks to expert author @GBrennanMD for providing this #tweetorial!
— ibs_ce (@ibs_ce) April 22, 2025