This slide presentation was developed by Dr. Lacy for an accredited CME program on IBS-C management.

1. Jointly Provided by
Patient POV: Incorporating Shared
Decision Making in IBS-C Management
Chair
Brian E. Lacy, MD, PhD, FACG
Professor of Medicine
Mayo Clinic
|
Patient Advocate
Regina Ciavarella

2. Disclosures
u Dr. Lacy discloses that he has received research
support from:
u Ironwood/AbbVie (virtual reality study)
u Bausch (gastroparesis study)
u G-tech (wireless motility patch study)
u He also provides consulting services to:
u Gemelli
u Sanofi
u Takeda
u Ms. Ciavarella discloses that she has served on the
patient council for Ardelyx

3. Learning Objectives
u Evaluate the diverse pathophysiologic
mechanisms of IBS-C and rationale for targeted
therapies
u Assess efficacy and safety data of current and
emerging pharmacologic therapies for IBS-C
u Apply strategies to optimize patient-provider
communication to manage symptoms and
improve quality of life in IBS-C

4. Overview
u IBS is a disorder of gut-brain
interaction (DGBI)
u DGBIs—formerly called functional
bowel disorders—arise due to
dysfunction in the brain-gut axis
u Underlying pathophysiology is
perceptive abnormality
u Predominant symptom is that of
abdominal pain
Chen et al, 2022.

5. Worldwide Prevalence of Functional GI Disorders
FGID, functional gastrointestinal disorders.
Sperber, 2021.

6. Epidemiology of IBS
u 4.1 - 4.6% worldwide prevalence – Rome IV
criteria1,2
u Prevalence in US – 5.3%
u Women > men (OR of 1.8)2
u Younger people more likely to be affected
u An equal opportunity offender – race, ethnicity,
religion, socioeconomic status
OR, odds ratio.
1. Palsson et al, 2020; 2. Sperber et al, 2021.

7. Impact of IBS on Patients
What Would You Be Willing to Give Up for
One Month of Symptom Free Relief?
IBS-C IBS-D
62% Alcohol 60%
58% Caffeine 53%
42% Sex 39%
25% Cell Phone 24%
21% Internet 22%
IBS is associated with a high disease burden
Ballou et al, 2019.
53%
36%
11%
0.4%
50%
37%
12%
0.6%
Extremely
Bothersome
Somewhat
Bothersome
A Little
Bothersome
Not Bothersome At
All
Reported Bothersomeness of GI
Symptoms in IBS-C and IBS-D
IBS-C IBS-D

8. Economic Burden of IBS-C
$8,621
$4,765
$0
$5,000
$10,000
$15,000
Patients with IBS-C Matched Controls
Healthcare
Costs
(2010
USD)
more hospitalizations
12%
22%
more ER visits
more prescription fills
26%
more office visits
22%
Doshi et al, 2014.
IBS-C is associated with increased resource utilization and
costs, driven primarily by outpatient visits

9. Patient Case
u Regina has had IBS-C symptoms her whole life
u Was told she had chronic constipation
u Told to eat more/less fiber, more/less greens, try
enemas, laxatives
u Learned to live with it
u Worst flare-up was 15-16 days where she
couldn’t eat/swallow
u Went back to the doctor and received
colonoscopy
u Was diagnosed with constipation and “kinky
intestines”

10. Patient Case (cont.)
u Regina did not get a diagnosis of IBS-C until
adulthood, last ~10 yrs
u Went to a different doctor & received
colonoscopy
u Doctor actively listened and diagnosed her
with IBS-C

11. Patient Case (cont.)
u Treatment history:
u Linaclotide for 2-3 years
uCouldn’t leave the house due to diarrhea
u Went back to doctor, received test on
rectum/colon to test muscles
u“Brain isn’t telling muscles to contract in the right
way”
u Tenapanor past ~4 months
uSometimes it works every day, sometimes it
doesn’t
uDiarrhea, have to be careful of diet, avoid dairy
u Magnesium – was taking too much

12. Proposed Pathophysiology of IBS
GI motor disturbances
Visceral
hypersensitivity
Abnormal central
processing of
sensations
Psychological
disturbances
Symptoms
Genetic factors
Environment
Consultation
Acute gastroenteritis
Abuse
history
Other
precipitating
factors
Food
Stress
coping
Immune dysfunction
Altered microbiota
Increased intestinal
permeability
Serotonin
Figure adapted from Rome Foundation.

13. Diagnosing IBS-C
Patient POV: Incorporating Shared Decision Making in IBS-C Management

14. Poll Question 1
u A confident diagnosis of IBS can be made in patients
with chronic symptoms of abdominal pain and
constipation (>6 months duration) without warning
signs using which collection of examinations and tests?
A. A careful history and exam, limited diagnostic testing, the
Rome IV criteria, and a colonoscopy with random biopsies.
B. A careful history and exam, limited diagnostic testing, the
Chicago criteria, and a colonoscopy with random biopsies.
C. A careful history and exam, limited diagnostic testing, and
the Rome IV criteria.
D. A careful history and exam, limited diagnostic testing, the
Rome IV criteria, and a lactulose breath test to rule out small
intestinal bacterial overgrowth.

15. Poll Question 1 – Correct Answer
u Correct answer: C
u A colonoscopy is not required to make the diagnosis
of IBS in all patients and is not recommended by the
American College of Gastroenterology guidelines
(answers A & B are incorrect)
u The Chicago criteria are used to diagnose
esophageal motility disorders (answer B is incorrect)
u Although small intestinal bacterial overgrowth may be
the cause of symptoms in some patients with IBS, or
may coexist in some patients with IBS, routine testing is
not recommended in all IBS patients (answer D is
incorrect)

16. Making a Positive Diagnosis of IBS:
5 Key Features
u Clinical history – symptoms are still the key
u Allergies/ADR, medical, surgical, dietary, psychological
u Alarm/warning signs
u Physical examination – include DRE
u Rome IV criteria
u Minimal (limited) laboratory tests
u When clinically indicated, colonoscopy or other
appropriate tests
ADR, allergic drug reaction; DRE, digital rectal examination.
Ford et al, 2017.

17. If alarm features are
present, investigate
and treat appropriately
CRC, colorectal cancer; IBD, inflammatory bowel disease.
Lacy et al, 2021.
Alarm Features for Organic Disorders
u Unintended weight loss (>10% in 3
months)
u Blood in stools not caused
(confirmed) by hemorrhoids or
anal fissures
u Symptoms that awaken patient
u Fever
u Anemia
u Palpable mass, ascites,
lymphadenopathy
u Family history of CRC, polyposis
syndromes, IBD, or celiac disease

18. Rome IV Criteria for IBS
Lacy et al, 2016.
Criteria fulfilled for the last 3 months with symptom onset
at least 6 months prior to diagnosis
Associated with
a change in frequency
of stool
Associated with a
change in
form of stool
Related to defecation
Recurrent abdominal pain
at least 1 day/week (on average) in the last 3 months
associated with ≥2 of the following:

19. Bloating
Pain
Distension
IBS
M
C
D
FC
FDr
FC: Functional constipation
FDr: Functional diarrhea
IBS-C: Irritable bowel syndrome with predominant constipation
IBS-D: Irritable bowel syndrome with predominant diarrhea
IBS-M: Irritable bowel syndrome with mixed bowel habits (D and C)
Type 1
Type 2
Type 3
Type 7
Type 5
Type 6
Type 4
Constipation
Lacy et al, 2016.
Functional Gastrointestinal Disorders

20. Rome IV: Limited Diagnostic Tests
Helps to Make a Positive Diagnosis
u In the appropriate patient, consider:
u “The 4 C’s” - CBC, CRP, fecal calprotectin, celiac
serologies
u All patients do not require testing
u No role for colonoscopy in all patients
u No good biomarker yet
u Take Home Message: Make a positive diagnosis
based on symptoms & limited testing and initiate
treatment – ideally at the first visit
CBC, complete blood count; CRP, C-reactive protein.
Ford et al, 2017.

21. Positive Diagnostic Approach for IBS –
Why Is this Important?
u Improves communication between patients and
providers
u Provides education and reassurance
u Leads to more rapid treatment initiation
u Prevents unnecessary testing
u Reduces risks of unnecessary testing
u Saves money

22. Treating IBS-C
Patient POV: Incorporating Shared Decision Making in IBS-C Management

23. Poll Question 2
u You are asked to see a 32-year-old woman with
symptoms of IBS and constipation. She has tried
several therapies without benefit. She asks about
tenapanor, and whether it might improve her
symptoms. What is the mechanism of action of this
FDA approved medication for IBS-C?
A. An osmotic agent
B. A stimulant laxative
C. A type 2 chloride channel activator
D. A sodium-hydrogen exchanger
E. A guanylate cyclase C activator

24. Poll Question 2 – Correct Answer
u Correct answer: D
u Tenapanor improves symptoms of IBS with constipation by
decreasing absorption of sodium from the small intestine and
colon (answer D is correct)
u Polyethylene glycol and magnesium products are examples of
osmotic agents (answer A is incorrect)
u Bisacodyl can be used to treat occasional constipation and is a
stimulant laxative (answer B is incorrect)
u Lubiprostone is FDA approved for the treatment of women with
IBS and constipation and is a type 2 chloride channel activator
(answer C is incorrect)
u Both linaclotide and plecanatide are approved for the treatment
of men and women with IBS and constipation; both agents are
examples of guanylate cyclase C activators (answer E is
incorrect)

25. IBS-C Treatment Options
u Agents with limited utility
u Over the counter agents
u Prescription medications

26. Therapies with Limited Utility in IBS
Therapy (subtype) Quality of Evidence ACG Task Force Conclusions1
Loperamide
(IBS-D)
Very low
Insufficient evidence to recommend use
Improves diarrhea, not abdominal pain
PEG
(IBS-C)
Low
Insufficient evidence to recommend use2
Improves SBMs, not abdominal pain
Prebiotics & Synbiotics
(all subtypes)
Very low
1 study with prebiotics; 2 studies of synbiotics;
unclear risk of bias; small sample size
Probiotics
(all subtypes)
Low
Insufficient/conflicting data on specific species,
strains, preparations
Antispasmodics
(all subtypes)
Very low
May relieve postprandial pain; unlikely to be
effective for chronic pain; AEs may limit use
ACG, American College of Gastroenterology; AEs, adverse events; PEG, polyethylene glycol; SBMs, spontaneous bowel movements.
1. Ford et al, 2018; 2. Chapman et al, 2013.

27. Pharmacologic Therapy: OTC Agents
Drug Class Agent
Approved
Indication
Evidence in
IBS-C
Evidence
in CIC
Comments
Fiber
Psyllium
Polycarbophil
Occasional
constipation
Moderate Low
Improvement in stool
consistency and
frequency; symptom
relief in IBS-C
Laxative
Stimulant laxatives
(bisacodyl,
sennosides)
Short-term
constipation
Observational
studies only
Moderate
Sodium picosulfate and
bisacodyl effective in
CIC
Osmotic laxatives
(polyethylene
glycol, lactitol)
CIC Very low High
Improves constipation;
no global symptom or
pain improvement in IBS-
C
Anionic
Surfactant
Docusate
Occasional
constipation
Low Low
Improved stool
consistency and
frequency, softened
stool
CIC, chronic idiopathic constipation; OTC, over-the-counter.
Sayuk et al, 2022; Cash, Siegel et al, 2005.
Common adverse events can include abdominal pain, diarrhea, nausea, flatulence, vomiting, and
electrolyte imbalances.

28. Fiber for IBS
RCTs, randomized controlled trials.
1. Moayyedi et al, 2014; 2. Lacy et al, 2021.
• 15 RCTs (N=946) demonstrated fiber
consistently better than placebo
• Bran did not help
Recommendation
Strong
Quality of
evidence
Moderate
We suggest
that soluble, but not
insoluble, fiber
be used to treat
global IBS symptoms2
RCTs of fiber vs placebo or
no treatment in IBS1

29. FDA-Approved Treatments for IBS-C
*Approved for women with IBS-C in 2002 but was voluntarily withdrawn in 2007, then subsequently reapproved in 2019 for use in women <65 years of age
without a history of CV ischemic events.
5-HT4, 5-hydroxytryptamine 4; Cl, chloride; CV, cardiovascular; GC-C, guanylate cyclase-C; NHE3, sodium/hydrogen exchanger;
Class Drug Name Formulation Dosage Mechanism of Action U.S. Approval for IBS-C
Secretagogues
Cl-
channel
activators
Lubiprostone Capsules 8 µg twice daily
↑ Cl- into intestinal lumen
↑ Intestinal fluid ↑ Transit
2008
(women ≥18 yrs)
GC-C
agonists
Linaclotide Capsules 290 µg once daily
↑ Cl- and HCO3- secretion into intestinal lumen
↑ Intestinal fluid ↑ Transit
2012
Plecanatide Tablets 3 mg once daily 2018
NHE3
inhibitor
Tenapanor Tablets 50 mg twice daily
↓ Absorption of Na+ from small intestine and
colon
↑ Intestinal fluid ↑ Transit
↓ Visceral hypersensitivity ↓ Intestinal
permeability
2019
5-HT
4
receptor
agonist
Tegaserod* Tablets 6 mg twice daily
Stimulates the peristaltic reflex
↑ Intestinal secretion
Inhibits visceral sensitivity
Enhances basal motor activity
2002 (women <65 yrs)

30. Mechanism of Action of IBS-C Treatments
DRUG CLASS MOA
MOA, mechanism of action.
Simrén et al, 2018; Sharma et al, 2021.
Tegaserod
Plecanatide
Guanylate
cyclase agonist
(GC-C)
• Increases intracellular cyclic
guanosine monophosphate,
creating an ion gradient that
promotes fluid secretion
• Inhibits colon nociception
Linaclotide
Tegaserod 5HT4 agonist • Accelerates GI motility
Tenapanor
Sodium/hydrogen
exchanger
isoform 3 inhibitor
• Creates an ion gradient that
promotes water and sodium
secretion into the intestinal
lumen
Lubiprostone
Type-2 chloride
channel activator
• Creates an ion gradient that
promotes water and sodium
secretion into the intestinal
lumen

31. Prosecretory Agents (Secretagogues)
u Lubiprostone contraindicated if mechanical gastrointestinal obstruction present
u Linaclotide contraindicated in children <6 years; avoid in children 6-18 years of age
u Plecanatide contraindicated in children <6 years; avoid in children 6-18 years of age
u Common AEs include diarrhea, nausea, vomiting, and abdominal cramping
Agent
Approved
Indication
Evidence
in IBS-C
Comments
Lubiprostone
Women with
IBS-C & CIC
High
Improvement in constipation as well
as global and abdominal symptoms
Linaclotide IBS-C & CIC High
Improvement in constipation as well
as global and abdominal symptoms
Plecanatide IBS-C & CIC High
Improvement in constipation as well
as global and abdominal symptoms
AE, adverse event.
Sayuk et al, 2022; Lacy et al, 2021; Cash, 2018; Patel et al, 2021.

32. Prosecretory Agents MOA
CFTR, cystic fibrosis transmembrane conductance regulator; cGMP, cyclic guanosine 3’,5’- monophosphate; ClC-2,
chloride channel protein 2; EC, enterochromaffin; GC-C, guanylyl cyclase; PKG, cGMP-dependent protein kinase.
Pannemans et al, 2018.
- NHE3 Inhibitor

33. Tenapanor: 26-Week Trial Results (N=620)
*Response = reduction in average weekly worst abdominal pain of ≥30.0% and an increase of ≥1 CSBM from baseline, both in the same week, for ≥6/12 weeks.
†At an incidence greater than placebo.
b.i.d, twice daily; CSBM, complete spontaneous bowel movement.
Chey et al, 2021; Chey et al, 2020.
Similar results observed in 12-week study
Most common adverse reactions (≥3%†)diarrhea (16.0%), abdominal distension (3.4%), flatulence (3.1%), and
nasopharyngitis (4.4%)
Combined Response
for ≥6 of the 12 Treatment Weeks*
P < 0.001
Abdominal Pain Response
for ≥6 of the 12 Treatment Weeks
P = 0.004
CSBM Response
for ≥6 of the 12 Treatment Weeks
P < 0.001

34. Poll Question 3
u You are studying for your GI certification
examination and are focusing on the topic of IBS
with constipation. How many medications are
FDA approved for the treatment of IBS-C and
which medication is FDA recommended as first
choice therapy for all patients with IBS and
constipation?
A. 6 and lubiprostone
B. 5 and none
C. 5 and linaclotide
D. 7 and rifaximin
E. 5 and polyethylene glycol

35. Poll Question 3 – Correct Answer
u Correct answer: B
u There are currently 5 FDA approved medications for
the treatment of IBS with constipation (answers A & D
are incorrect).
u Given an absence of head-to-head studies, the FDA
cannot recommend a single agent as the first choice
for all patients; similarly, guidelines from all GI societies
do not recommend a single first-line agent for all
patients with IBS-C (answers A, C, D, E are incorrect)
u Of note, rifaximin is FDA approved for the treatment of
IBS, but for patients with diarrhea and not constipation

36. IBS Guidelines in the US
IBS-C IBS-D
Lacy et al, 2021; Chang et al, 2022; Smalley et al, 2019; Lembo et al, 2022.

37. Comparison of ACG and AGA Guidelines:
Recommendations for IBS-C Therapies
a
Limited use of tegaserod in women <65 years of age with ≤1 cardiovascular risk factors who have not adequately responded to secretagogues.
1. Lacy et al, 2021; 2. Chang et al, 2022.
Therapy
ACG Recommendation1 AGA Recommendation2
–/+ Type
Quality
of evidence –/+ Type
Quality
of evidence
Antispasmodics – Conditional Low + Conditional Low
Lubiprostone + Strong Moderate + Conditional Moderate
GC-C agonists
Linaclotide
Plecanatide
+
Strong
High +
+
Strong
Conditional
High
Moderate
Tegaseroda + Conditional Low + Conditional Moderate
Tenapanor
Not included in
analysis
+ Conditional Moderate

38. Novel Therapies
Patient POV: Incorporating Shared Decision Making in IBS-C Management

39. Novel Therapies for IBS-C
u Vibrating capsule
u Fecal transplant
u Neuromodulators
u Brain-gut behavioral therapy
u Virtual reality

40. Rao et al, 2023.
Rome III criteria
Vibrating Capsule Treatment for Chronic Constipation
Phase 3, Double Blind, Multicenter, Placebo Controlled Trial
Vibrating capsule was superior to placebo capsule in improving
constipation symptoms and quality of life and was safe and well tolerated

41. Fecal Microbiota Transplant for IBS
CI, confidence interval; FMT, fecal microbiota transplant; RR, response rate.
1. Xu et al, 2019; 2. Lacy et al, 2021.
• Altering the gut microbiome improves
IBS symptoms in some patients
• Separate meta-analysis (5 studies,
N=267) found donor stool to be better
than autologous
• Too early for clinical use, needs to be
studied much more thoroughly
Recommendation
Strong
Quality of
evidence
Very low
We recommend
against the use
of fecal transplant
for treatment of
global IBS symptoms2
Studies for efficacy of FMT vs placebo on
global improvement of IBS symptoms1
Study
FMT
N
Placebo
N
RR
(95% CI)
Johnsen 2017 60 30 1.50 (0.92, 2.44)
Holvoet 2017 42 22 1.83 (0.87, 3.87)
Aroniadis 2018 24 24 0.67 (0.38, 1.17)
Halkjaer 2018 26 26 0.42 (0.23, 0.78)
Total 152 102 0.93 (0.48, 1.79)

42. ATLANTIS Trial: Amitriptyline for IBS
u Randomized, double-blind, placebo-controlled
u 55 primary care practices in England
u Rome IV criteria – all IBS subtypes; adults >18 yrs
u Patients had failed dietary interventions and OTC
agents
u 10 mg amitriptyline titrated to 20 or 30 mg vs.
placebo; 6 months
u N=463 (mean age = 48.5; 68% female)
u Patients randomized to amitriptyline were more
likely to report improved global IBS symptoms
compared to placebo (OR 1.78)
u 13% discontinued amitriptyline vs 9% on placebo
OR, odds ratio; OTC, over-the-counter.
Ford et al, 2023.

43. Gut-Directed Psychotherapies IBS
BGP, brain gut psychotherapy; CBT, cognitive behavioral therapy; HPA, hypothalamo-pituitary-adrenal; IE, interoceptive exposure; NNT, number
needed to treat.
1. Chey et al, 2021. 2. Lacy et al, 2021.
• Multiple gut-directed
psychotherapies include CBT
and hypnotherapy
• Large RCTs for CBT show
benefit (NNT=4)
Recommendation
Conditional
Quality of
evidence
Very low
We suggest
that gut-directed
psychotherapies
be used to treat
global IBS symptoms2
Gut-directed psychotherapies target cognitive and
affective factors that drive symptom experience1

44. Virtual Reality (VR) for the Treatment of IBS

45. Brain
Gut
Visceral
afferent
signaling
Central
downregulation
VR
Could VR Improve IBS Symptoms?
Lacy et al, 2023.

46. Patient-Provider Communication
Patient POV: Incorporating Shared Decision Making in IBS-C Management

47. Poll Question 4
u Patient-centered care for the treatment of IBS
with constipation should include which key
components for all patients?
A. Listen, educate, order colonoscopy, refer to
psychology
B. Listen, educate, order colonoscopy, make a confident
diagnosis
C. Listen, educate, reassure, make a confident diagnosis
D. Listen, reassure, order colonoscopy, refer to psychology

48. Poll Question 4 – Correct Answer
u Correct answer: C
u Effective management of patients with IBS-C includes a patient-
centered approach with an emphasis on communication and
joint decision making.
u Listening to the patient is critical; patient satisfaction is improved
by educating the patient to their condition and reassuring them
that IBS does not shorten lifespan and does not increase the risk
for colorectal cancer or IBD (common misconceptions)
u Although some patients may have co-existing psychological
distress, referring all patients for psychological evaluation is not
appropriate (answers A and D are not correct)
u Limited testing may be appropriate in some patients; however,
reassurance is more important and strengthens the patient-
provider relationship. A colonoscopy is not required in all patients
with IBS (answers A, B and D are not correct)

49. Establishing the Patient-Provider
Relationship
Patient self-reporting is essential to diagnosis and
determining therapy response in IBS-C
u Symptom reporting influenced by age, sex, and
health literacy level
u Negative patient-clinician relationships and
dissatisfaction can result in worse outcomes
Clinicians need to adopt a patient-centered
communication style when managing patients with
IBS-C
Kassebaum-Ladewski et al, 2022.

50. The Ideal Patient Experience
u Going to see a doctor that will actively listen to what I
am explaining to them about my symptoms
u Having empathy for what I am going through
u Being prepared for my appointment, meaning
reviewing my chart, and having some background on
my illness
u Knowledge about medications, procedures, nutrition.
Anything that could help with my problem
u Most important, acknowledging that I actually have
an issue, and not dismissing me to let me think it's in my
head
u Realizing that IBS is real, and it affects many aspects of
my life

51. Create a Shared Understanding of Patients'
IBS-C Symptoms
Halpert, 2018.
Elicit Patient’s
Perspective
Understand the patient’s
beliefs regarding the illness
“What do you think is the
cause of your illness?”
“What do your family and
friends think about your
condition?”
Determine the impact on quality of life
“How are these symptoms affecting
your life?”
Disease-related
anxiety
“What are your
concerns in relation
to your IBS?”
Negotiate
Mutual
Treatment Plan
Use patient’s frame of
reference
“You described the
burning sensation that . . . ”
Involve the patient in decision-making
“Which of the treatments we talked
about are you most interested in
trying?”
“What do you think will help the most?”
Explore plan
acceptability and
barriers
“Do you think you
will be able to
stick to this plan?”
“How can we
make it easier?”
Set realistic goals
“Let’s work towards improving your
symptoms, even though it may not
be possible to resolve them
completely.”
Encourage questions
“What questions do you
have about..?”

52. Patient-Centered Care in IBS-C
Listen
Educate
Reassure
Make a confident diagnosis
Improve symptoms
• Treatment options explained
• Risks/benefits reviewed

53. Make the Diagnosis and Initiate
Treatment
u A confident diagnosis is important
u Address goals and concerns
u Review treatment options together
u Initiate therapy based on the
predominant symptom

54. Examples of Clear vs. Qualified
Language
Clear
u “he has”
u “is suffering from”
u “has been diagnosed with”
u “his diagnosis is that of”
u “definitely has”
u “I have you diagnosed with”
Qualified
u “may be having”
u “it is possible that”
u “quite fits the picture of”
u “is probably a reasonable
label”
u “working impressions”
u “managed as a case of”
Linedale et al, 2016.

55. 55
Summary
u IBS-C is a subtype of IBS characterized by constipation and
recurrent abdominal pain; it has a substantial impact on
the lives of patients
u Pharmacologic FDA approved treatment options include
secretagogues (lubiprostone, linaclotide, plecanatide)
and an NHE3 inhibitor (tenapanor)
u In IBS-C patient-centered care, patients, families, and the
healthcare team collaborate to make management
decisions that are tailored to the needs of each individual
patient
u Patient education is critical to effective care in IBS-C and
can be achieved by individualizing learning, stimulating
interest, and including members of the patient’s
community

56. Thank you for joining us today!
u In 4 weeks, you will receive a follow-up survey to
see if you’ve been able to implement any of your
intended changes as a result of what you learned
u We are excited to see the impact of this
educational activity on patient care in IBS-C!
u If you have any questions, send us an email:
devi@cmespark.com

57. References
u Ballou S, McMahon C, Lee H, et al (2019). Effects of Irritable Bowel Syndrome on Daily Activities Vary Among
Subtypes Based on Results From the IBS in America Survey. Clin Gastroenterol Hepatol. 17(12):2471-78.e3.
DOI:10.1016/j.cgh.2019.08.016
u Cash BD (2018). Understanding and managing IBS and CIC in the primary care setting. Gastroenterol
Hepatol (N Y). 14(5 Suppl 3):3-15.
u Chang L, Sultan S, Lembo A, et al (2022). AGA Clinical Practice Guideline on the Pharmacological
Management of Irritable Bowel Syndrome With Constipation. Gastroenterology. 163(1):118-36.
DOI:10.1053/j.gastro.2022.04.016
u Chapman RW, Stanghellini V, Geraint M, et al (2013). Randomized clinical trial: macrogol/PEG 3350 plus
electrolytes for treatment of patients with constipation associated with irritable bowel syndrome. Am J
Gastroenterol. 108(9):1508-15. DOI:10.1038/ajg.2013.197
u Chen M, Ruan G, Chen L, et al (2022). Neurotransmitter and intestinal interactions: focus on the microbiota-
gut-brain axis in irritable bowel syndrome. Front Endocrinol (Lausanne). 13:817100.
DOI:10.3389/fendo.2022.817100
u Chey WD, Keefer L, Whelan K, et al (2021). Behavioral and diet therapies in integrated care for patients with
irritable bowel syndrome. Gastroenterology. 160(1):47-62. DOI:10.1053/j.gastro.2020.06.099
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