{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 13, Ep 2 of 2: IBS D Neuromod Bloating","html":"","width":"100%","height":180,"duration":921,"description":"Episode two of the IBS and Functional Bowel chapter covers the diarrhea-predominant subtype, the neuromodulators and behavioral therapies that work across subtypes, and the mechanistic workup of bloating. Drug selection is mechanism-matched to the dominant symptom and driver, not subtype-matched in the abstract. Carry mechanism, subtype indication, and contraindication together to pick the right answer.\n \nTopics covered\n\nIBS-D pharmacology\nLoperamide, rifaximin, eluxadoline\nBile acid sequestrants and alosetron\nNeuromodulators by side-effect match\nAntispasmodics and peppermint oil\nBehavioral and mind-body therapy\nBloating versus distension\nLow-FODMAP diet and fiber\n \n \nKey decisions\n\nLoperamide controls stool frequency and urgency but never abdominal pain; for crampy IBS-D add a low-dose tricyclic or rifaximin, not more loperamide.\nRifaximin responders who relapse can be retreated with the same 14-day course, up to two retreatments for three courses total; never lock the patient out.\nEluxadoline is absolutely contraindicated after cholecystectomy (sphincter of Oddi spasm causing pancreatitis), and with biliary obstruction, heavy alcohol use, pancreatitis history, or severe constipation.\nAlosetron is restricted to women with severe refractory IBS-D, carries ischemic colitis and severe constipation boxed warnings, and is contraindicated in the mixed subtype; obstipation means stop and evaluate, not titrate.\nFor IBS-D neuromodulation, low-dose tricyclics are favored because the anticholinergic transit slowing is therapeutic; switch amitriptyline to nortriptyline or desipramine for side effects, and SSRIs do not help IBS-D pain.\nAbdomino-phrenic dyssynergia is the answer for visible distension out of proportion to luminal content, with daytime progression, overnight resolution, and no excess gas on CT, treated with diaphragmatic breathing retraining.\n \n \nThis is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your understanding, and we...","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}