A Narrative Review of Irritable Bowel Syndrome with Diarrhea: A Primer for Primary Care Providers

Abstract

Irritable bowel syndrome with diarrhea (IBS-D) is a chronic disorder of gut-brain interaction, characterized by recurrent abdominal pain in association with more frequent, loose stools. The pathophysiology of irritable bowel syndrome (IBS) includes disordered gut motility, alterations in gut microbiota, neural-hormonal system abnormalities, immune reactivity, and visceral hypersensitivity. Timely diagnosis of IBS-D can be achieved easily using clinical criteria. Formal IBS diagnosis is important for optimizing treatment and patient outcomes and facilitating patient access to appropriate educational resources. Yet, given the symptom overlap with other gastrointestinal conditions, diagnosis of IBS-D often is perceived to be challenging. Treatment of IBS includes both nonpharmacologic and pharmacologic options. Rifaximin, alosetron, and eluxadoline are effective treatments indicated for IBS-D, but have limited availability internationally. Dietary approaches may also be indicated for certain patients with IBS-D. Psychological interventions may be effective in treating abdominal pain alone and global symptoms in IBS. We describe use of these diverse therapies and provide an overview to facilitate the primary care provider's approach to distinguishing IBS-D from other conditions with symptom overlap.

Can physical exercise help people with irritable bowel syndrome? How substantial is the evidence?

“…In contrast to vigorous exercise, light-moderate exercise can increase the secretion of secretory immune globulin A, which plays a significant role in boosting the immune system and providing protection against different pathogens [57,58]. Increasing physical activity is also associated with enhanced intestinal immune function due to increased microbial diversity resulting in increased short chain fatty acids (SCFA), which can modulate energy balance, increase nutrient availability, and promote intestinal barrier maintenance and homeostasis [12,38,59,60].…”

Treatment-Free Interval: A Novel Approach to Assessing Real-World Treatment Effectiveness and Economic Impact Among Patients with Irritable Bowel Syndrome with Diarrhea

“…Clinical management of IBS-D is complicated by the heterogenous presentation of the condition and multiple treatments are often needed to manage symptoms [ 1 , 3 , 6 ]. Historically, antispasmodics and over-the-counter medications, such as antidiarrheals, have been used [ 3 ]; however, these treatments do not typically improve abdominal pain or bloating.…”

“…Clinical management of IBS-D is complicated by the heterogenous presentation of the condition and multiple treatments are often needed to manage symptoms [ 1 , 3 , 6 ]. Historically, antispasmodics and over-the-counter medications, such as antidiarrheals, have been used [ 3 ]; however, these treatments do not typically improve abdominal pain or bloating. In recent years, the US Food and Drug Administration (FDA) has approved three agents for the treatment of IBS-D: rifaximin (an antibiotic), eluxadoline (a mixed opioid receptor agonist/antagonist), and alosetron (a serotonin antagonist) [ 7 – 10 ].…”

Evaluation of the Antioxidant and Inhibitory Activity of Aloe vera plant Extract (Fermented by Lactobacillus plantarum bacteria) Against the Pathogenic Bacteria Isolated from Diarrhea Infections

“…diarrhoea can be defined as a condition characterised by increased bowel movement frequencies, liquid faecal secretions, and loss of large amounts of water and mineral salts. It is a prevalent disease worldwide, especially in developing countries, where children and immunocompromised people have a high risk of infection (Dhimal et al, 2022;Moshiree, Heidelbaugh and Sayuk, 2022). As a result of the development of resistance of microorganisms to antibiotics, it has become necessary to find alternative materials that have antibacterial inhibitory effects.…”