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Diagnosis and treatment of irritable bowel syndrome with predominant constipation in the primary-care setting: focus on linaclotide

Authors Chandar AK

Received 10 June 2017

Accepted for publication 15 September 2017

Published 31 October 2017 Volume 2017:10 Pages 385—393


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Apoorva Krishna Chandar1,2

1Department of Gastroenterology and Liver Disease, Case Western Reserve University, 2Digestive Health Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

Abstract: Irritable bowel syndrome (IBS) is a complex functional gastrointestinal disorder that is exceedingly common in clinical practice. IBS with predominant constipation (IBS-C) is a subtype of IBS that accounts for more than a third of the IBS diagnosed. Diagnosis of IBS requires a careful personalized approach, a comprehensive clinical history, limited but relevant investigations, and continued follow-up. Major IBS societies and guidelines recommend offering a positive diagnosis of IBS based on presenting symptomatology. Abdominal pain that may or may not be relieved by defecation is the cardinal symptom of IBS; distension and bloating are other common symptoms. Careful attention should be paid to alarm symptoms before a diagnosis of IBS is made. Pharmacotherapy with linaclotide is recommended for moderate–severe IBS-C, based on high-quality evidence from randomized controlled trials. Diarrhea is the major side effect of linaclotide, and limited cost-effectiveness data currently exist.

Keywords: irritable bowel syndrome, irritable bowel syndrome with predominant constipation, primary care, Rome IV, linaclotide, systematic review

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