Diagnosis and treatment of irritable bowel syndrome with diarrhea: Key clinical considerations.
Amy M Ladewski, Kimberly D Orleck, Kristina F Skarbinski
PMID 41529101WHAT IT FOUND
Nurse practitioners and physician assistants can diagnose irritable bowel syndrome with diarrhea from symptoms, limited tests, and absent alarm features, then personalize diet, medication, or gut-brain therapy choices.
Key findings
01For patients meeting Rome IV criteria without alarm features, a symptom-based diagnosis may be accurate in up to 98% of cases.
02In two phase 3 randomized trials, more patients with IBS-D achieved adequate global IBS symptom relief with rifaximin than placebo (40.7% vs 31.7%).
03Treatment selection should target the patient's most bothersome symptoms and may include dietary modification, soluble fiber, peppermint oil, antidiarrheals, FDA-approved drugs, neuromodulators, or gut-brain behavioral therapy.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a narrative review, not a systematic review or original trial, so it may reflect the authors' selection of sources. The case presentations describe individual patients and cannot show that any single treatment caused improvement. The low-FODMAP diet recommendation is conditional and based on very low-quality evidence. Several treatments have narrow indications or safety limits, including alosetron for severe IBS-D in women and eluxadoline contraindications related to the gallbladder, pancreatitis, or alcohol use. The review does not report how many studies were screened or included.
The easy way to misread this
Do not read the case presentations as proof that rifaximin alone caused improvement. A repeat rifaximin course was given with dietary counseling and dairy avoidance, so the contribution of each part cannot be separated.