Pearls from 6/22/21 Medicine LEADS

Wednesday, June 23, 2021

The June 22, 2021 session of Duke Medicine LEADS featured David Tendler, MD, presenting "Evaluation and Management of Functional Bowel Disease."

Here are pearls and takeaways from the session:

  1. Discussing IBS and functional dyspepsia in terms that patients can relate to like: “It’s the gut’s version of migraines.” You have a Type A [esophagus, stomach, colon, etc].”
  2. Identify the predominant symptoms (pain, bloating, diarrhea, constipation, etc) to help guide management. If diarrhea predominant, review meds and consider carbohydrate maldigestion, celiac, SIBO, microscopic colitis, bile salt malabsorption, etc. If functional bloating, evaluate dietary contributors such as FODMAPs, excessive fiber intake, and artificial sweeteners.
  3. Effective management of IBS requires a multifaceted approach, including diet and lifestyle changes tailored to the predominant symptoms, in addition to medications. For IBS-D consider TCAs, rifaximin, alosetron, or VIberzi. For IBS-C, the efficacy of all secretagogues are similar (e.g., Linzess, Trulance, Amitiza).
  4. Peppermint oil is good for abdominal pain and bloating. IBGard is the brand name and it is OTC. 
  5. You can also try FDGard (Iberogast liquid) for functional dyspepsia.
  6. Soluable fibers like Metamucil are recommended but can cause bloating. 
  7. Probiotics have limited data and currently are not recommended.

Recommendations reflect new ACG Clinical Guidelines for IBS January 2021

Watch the recorded session

Duke Medicine Learning, Education, and Discussion Series (LEADS) takes place each Tuesday at 12 p.m. Learn more and see schedule of upcoming sessions.