Listen, Look, and Learn From Your Patients: Diagnosing and Treating IBS-C

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Listen, Look, and Learn From Your Patients: Diagnosing and Treating IBS-C

Brian E. Lacy, MD, PhD, FACG

Release Date: October 18, 2016
Expiration Date: October 17, 2017

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Activity Description
This interactive, on-demand activity introduces KM, a woman with chronic abdominal pain and constipation. She has trouble discussing her symptoms and seeks pain relief. In 30 minutes, review this case-based activity and learn about:

Communication skills and tools that help patients talk about bowel habits
Positive diagnosis of IBS and its subtypes without lab testing
Selecting appropriate treatment for IBS-C based on underlying pathophysiology, severity of disease, and clinical trial data

Learning Objectives

Upon completion of this educational activity, participants should be able to:

Develop strategies to improve physician-patient communication regarding IBS symptoms and management
Use updated diagnostic guidelines to inclusively diagnose IBS
Identify the pathogenesis of the subtypes of IBS to effectively initiate treatment and sustain effective care
Effectively match targeted therapies for IBS-C to the pathophysiologic mechanisms underlying the disorder

Faculty

Brian E. Lacy, MD, PhD, FACG (Activity Chair)

Professor of Medicine

Geisel School of Medicine at Dartmouth

Chief, Section of Gastroenterology and Hepatology

Director, GI Motility Laboratory

Dartmouth-Hitchcock Medical Center

Lebanon, NH

Faculty Biography

Brian E. Lacy, PhD, MD, FACG

Brian E. Lacy, PhD, MD, FACG, is Professor of Medicine at the Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He is also Section Chief of the Division of Gastroenterology and Hepatology and Director of the GI Motility Laboratory at the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire. Dr Lacy received his doctorate in cell biology from Georgetown University in Washington, DC, and his medical degree from the University of Maryland in Baltimore. Dr Lacy was a resident in internal medicine at the Dartmouth-Hitchcock Medical Center, where he continued his training as Chief Resident and then as a Fellow in gastroenterology.

Dr Lacy’s clinical and basic science research interests focus on disorders of gastrointestinal motility, with an emphasis on irritable bowel syndrome, dyspepsia, gastroparesis, acid reflux disease, constipation, intestinal pseudo-obstruction, achalasia, and visceral pain. He is the author or co-author of over 120 peer-reviewed articles, as well as numerous textbook chapters on gastrointestinal motility disorders and functional bowel disorders. Dr Lacy also serves as a reviewer for a number of scientific journals, and is a member of the American College of Gastroenterology, the American Gastroenterology Association, the American Motility Society, and the Rome Committee. He is the co-author of a book for the general public on acid reflux disease, Healing Heartburn, author of Making Sense of IBS, a book for the general public on irritable bowel syndrome, and editor and author of 2 books for healthcare providers entitled Curbside Consultations in IBS: 49 Clinical Questions and Functional and Motility Disorders of the Gastrointestinal Tract. In addition, he is the former Editor in Chief of the journal Clinical and Translational Gastroenterology and is the current Co-editor in Chief of the American Journal of Gastroenterology.

Disclosure Statements
In accordance with the Accreditation Council for Continuing Medical Education, the NCAFP requires that any person who is in a position to control the content of a CME activity must disclose all relevant financial relationships they have with a commercial interest.

Faculty
Brian E. Lacy, MD, PhD, FACG (Activity Chair)
Advisory Board: Advisory Board-for scientific information: Ironwood Pharmaceuticals; Salix Pharmaceuticals, Inc; Takeda Pharmaceuticals U.S.A., Inc

Independent Reviewer
Alisa C. Nance, MD

Nothing to disclose with regard to commercial support

Educational Planning Committee
NCAFP
Marietta Ellis

Nothing to disclose with regard to commercial support

Spire Learning

Christine Kocienda

Erika Langsfeld, PhD

Nothing to disclose with regard to commercial support

Disclaimer

The content and views presented in this educational activity are those of the presenter and do not necessarily reflect those of the NCAFP, Spire Learning, or Allergan. This material is prepared based upon a review of multiple sources of information, but it is not exhaustive of the subject matter. Therefore, healthcare professionals and other individuals should review and consider other publications and materials on the subject matter before relying solely upon the information contained within this educational activity.

Off-label Statement

The faculty will discuss non-FDA-approved uses of fiber, stool softeners, laxatives, and selective serotonin reuptake inhibitors (SSRIs) for the management of IBS-C. Participants should appraise the information presented critically and are encouraged to consult appropriate resources for any product or device mentioned in this activity.

Target Audience

Family physicians with an interest in the management of IBS-C

Accreditation

This Enduring Material activity, Listen, Look, and Learn From Your Patients: Diagnosing and Treating IBS-C, has been reviewed and is acceptable for up to 0.50 Prescribed credit(s) by the American Academy of Family Physicians. Term of approval begins 09/01/2016. Term of approval is for one year from this date. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AMA/AAFP Equivalency: AAFP Prescribed credit is accepted by the American Medical Association as equivalent to AMA PRA Category 1 credit(s)™ toward the AMA Physician’s Recognition Award. When applying for the AMA PRA, Prescribed credit earned must be reported as Prescribed, not as Category 1.

Method of Participation
There is no fee to participate in the activity, which should take approximately 30 minutes to complete. If you wish to receive full credit for participating in this activity, you must view the online activity and complete the online evaluation with an 80% passing score on the posttest. We cannot award credit unless all steps are completed.

You will need a RapidCME account in order to access the posttest and evaluation, and to claim credit. If you do not have a RapidCME account, you will be asked to set up an account at the end of the activity, prior to completion of the posttest and evaluation.

Hardware/Software Requirements

A computer with an Internet connection

This educational activity is jointly provided by the North Carolina Academy of Family Physicians (NCAFP) and Spire Learning.

This educational activity is supported by an educational grant from Allergan.

References for Listen, Look, and Learn From Your Patients: Diagnosing and Treating IBS-C

Suggested Related Content

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http://www.rapidcme.com/activity.aspx?actID=17

References for Pre-/Postassessment Questions

1. Drossman DA. 2012 David Sun lecture: helping your patient by helping yourself--how to improve the patient-physician relationship by optimizing communication skills. Am J Gastroenterol. 2013;108(4):521-528.

2. Lacy BE, Weiser K, Noddin L, et al. Irritable bowel syndrome: patients' attitudes, concerns and level of knowledge. Aliment Pharmacol Ther. 2007;25(11):1329-1341.

3. Mearin F, Lacy BE, Chang L, et al. Bowel Disorders. Gastroenterology. 2016. Epub ahead of print.

References for Core Activity

1. Drossman DA, Camilleri M, Mayer EA, Whitehead WE. AGA technical review on irritable bowel syndrome. Gastroenterology. 2002;123(6):2108-2131.

2. Drossman DA. 2012 David Sun lecture: helping your patient by helping yourself--how to improve the patient-physician relationship by optimizing communication skills. Am J Gastroenterol. 2013;108(4):521-528.

3. Halpert A, Dalton CB, Palsson O, et al. Irritable bowel syndrome patients' ideal expectations and recent experiences with healthcare providers: a national survey. Dig Dis Sci. 2010;55(2):375-383.

4. Dalton CB, Drossman DA, Hathaway JM, Bangdiwala SI. Perceptions of physicians and patients with organic and functional gastrointestinal diagnoses. Clin Gastroenterol Hepatol. 2004;2(2):121-126.

5. Dixon-Woods M, Critchley S. Medical and lay views of irritable bowel syndrome. Fam Pract. 2000;17(2):108-113.

6. Drossman DA. Do psychosocial factors define symptom severity and patient status in irritable bowel syndrome? Am J Med. 1999;107(5A):41S-50S.

7. Canavan C, West J, Card T. The epidemiology of irritable bowel syndrome. Clin Epidemiol. 2014;6:71-80.

8. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012;10(7):712-721.e4.

9. Hungin AP, Chang L, Locke GR, Dennis EH, Barghout V. Irritable bowel syndrome in the United States: prevalence, symptom patterns and impact. Aliment Pharmacol Ther. 2005;21(11):1365-1375.

10. American College of Gastroenterology Task Force on Irritable Bowel Syndrome, Brandt LJ, Chey WD, et al. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol. 2009;104(suppl 1):S1-S35.

11. Cash BD, Rubenstein JH, Young PE, et al. The prevalence of celiac disease among patients with nonconstipated irritable bowel syndrome is similar to controls. Gastroenterology. 2011;141(4):1187-1193.

12. Begtrup LM, Engsbro AL, Kjeldsen J, et al. A positive diagnostic strategy is noninferior to a strategy of exclusion for patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. 2013;11(8):956-962.e1.

13. Pare P, Bridges R, Champion MC, et al. Recommendations on chronic constipation (including constipation associated with irritable bowel syndrome) treatment. Can J Gastroenterol. 2007;21(suppl B):3B-22B.

14. Mearin F, Lacy BE, Chang L, et al. Bowel Disorders. Gastroenterology. 2016. Epub ahead of print.

15. Mearin F. Irritable bowel syndrome (IBS) subtypes: nothing resembles less an IBS than another IBS. Rev Esp Enferm Dig. 2016;108(2):57-58.

16. Andrae DA, Patrick DL, Drossman DA, Covington PS. Evaluation of the Irritable Bowel Syndrome Quality of Life (IBS-QOL) questionnaire in diarrheal-predominant irritable bowel syndrome patients. Health Qual Life Outcomes. 2013;11:208.

17. Clarke G, Quigley EM, Cryan JF, Dinan TG. Irritable bowel syndrome: towards biomarker identification. Trends Mol Med. 2009;15(10):478-489.

18. Saad RJ, Chey WD. Recent developments in the therapy of irritable bowel syndrome. Expert Opin Investig Drugs. 2008;17(2):117-130.

19. Camilleri M. Evolving concepts of the pathogenesis of irritable bowel syndrome: to treat the brain or the gut? J Pediatr Gastroenterol Nutr. 2009;48(suppl 2):S46-S48.

20. Johanson JF, Kralstein J. Chronic constipation: a survey of the patient perspective. Aliment Pharmacol Ther. 2007;25(5):599-608.

21. Lacy BE, Weiser K, Noddin L, et al. Irritable bowel syndrome: patients' attitudes, concerns and level of knowledge. Aliment Pharmacol Ther. 2007;25(11):1329-1341.

22. Johannesson E, Simren M, Strid H, Bajor A, Sadik R. Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol. 2011;106(5):915-922.

23. Johannesson E, Ringstrom G, Abrahamsson H, Sadik R. Intervention to increase physical activity in irritable bowel syndrome shows long-term positive effects. World J Gastroenterol. 2015;21(2):600-608.

24. Moayyedi P, Quigley EM, Lacy BE, et al. The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol. 2014;109(9):1367-1374.

25. Chapman RW, Stanghellini V, Geraint M, Halphen M. Randomized clinical trial: macrogol/PEG 3350 plus electrolytes for treatment of patients with constipation associated with irritable bowel syndrome. Am J Gastroenterol. 2013;108(9):1508-1515.

26. Ford AC, Moayyedi P, Lacy BE, et al. American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. Am J Gastroenterol. 2014;109(suppl 1):S2-S26; quiz S27.

27. Drossman DA, Morris CB, Schneck S, et al. International survey of patients with IBS: symptom features and their severity, health status, treatments, and risk taking to achieve clinical benefit. J Clin Gastroenterol. 2009;43(6):541-550.

28. Johanson JF, Drossman DA, Panas R, Wahle A, Ueno R. Clinical trial: phase 2 study of lubiprostone for irritable bowel syndrome with constipation. Aliment Pharmacol Ther. 2008;27(8):685-696.

29. Drossman DA, Chey WD, Johanson JF, et al. Clinical trial: lubiprostone in patients with constipation-associated irritable bowel syndrome--results of two randomized, placebo-controlled studies. Aliment Pharmacol Ther. 2009;29(3):329-341.

30. Chey WD, Lembo AJ, Lavins BJ, et al. Linaclotide for irritable bowel syndrome with constipation: a 26-week, randomized, double-blind, placebo-controlled trial to evaluate efficacy and safety. Am J Gastroenterol. 2012;107(11):1702-1712.

31. Rao S, Lembo AJ, Shiff SJ, et al. A 12-week, randomized, controlled trial with a 4-week randomized withdrawal period to evaluate the efficacy and safety of linaclotide in irritable bowel syndrome with constipation. Am J Gastroenterol. 2012;107(11):1714-1724; quiz 1725.

32. Ford AC, Quigley EM, Lacy BE, et al. Effect of antidepressants and psychological therapies, including hypnotherapy, in irritable bowel syndrome: systematic review and meta-analysis. Am J Gastroenterol. 2014;109(9):1350-1365; quiz 1366.