{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 13, Ep 1 of 2: ROME IV Pathophys IBS C","html":"<iframe width=\"100%\" height=\"180\" frameborder=\"no\" scrolling=\"no\" seamless src=\"https://share.transistor.fm/e/920484bf\"></iframe>","width":"100%","height":180,"duration":907,"description":"Episode one of two on Irritable Bowel Syndrome and functional bowel, covering positive diagnosis, Rome IV criteria, and subtyping. It maps the brain-gut model and its five mechanisms onto the drug classes. It closes with the mechanism-targeted pharmacology of constipation-predominant IBS.\n \nTopics covered\n\nRome IV positive diagnosis\nIBS subtyping by Bristol form\nAlarm features and targeted testing\nIBS-D differential and mimics\nBrain-gut five-mechanism model\nVisceral hypersensitivity\nIBS-C secretagogues\nPrucalopride prokinetic\n \n \nKey decisions\n\nIBS is a positive clinical diagnosis, not exclusion: apply after a brief targeted screen for celiac (tTG plus total IgA), IBD (CRP and calprotectin), and Giardia, not a full rule-out workup.\nRome criterion is pain related to defecation (not necessarily improved by it), at least one day a week over three months; subtype by Bristol form on abnormal-BM days only.\nAbnormal screening tests suspend the IBS label: elevated calprotectin, high CRP, or anemia demands colonoscopy with ileal biopsy and small-bowel imaging; positive tTG with normal IgA is celiac until proven otherwise.\nLubiprostone dose split is tested: 8 mcg BID for IBS-C (women), versus 24 mcg BID for chronic idiopathic constipation; give with food to blunt nausea.\nLinaclotide 290 mcg once daily on an empty stomach at least 30 minutes before the first meal; plecanatide 3 mg with or without food; interchangeable, both boxed warning for dehydration in young children.\nPrucalopride is a selective 5-HT4 prokinetic (2 mg daily, 1 mg in renal impairment) approved for chronic idiopathic constipation, not IBS-C; designed for cardiac selectivity, the answer for refractory slow-transit constipation after secretagogue failure.\n \n \nThis is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your understanding, and we hope you enjoyed this content.\n \n \nStudy the full chapter on Board Pearls, with practice questions, tables and primary-guideline...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}