Fast Five Quiz: Do You Know Key Differences Between Irritable Bowel Syndrome and Inflammatory Bowel Disease?

Jamie Shalkow, MD; Daniel Margain, MD

Disclosures

July 12, 2018

UC is a surgically curable disease. However, CD can involve any segment of the GI tract from the mouth to the anus; surgical resection is not curative, as recurrence is the norm. In addition, repeated need for surgery and bowel resection may result in short gut syndrome and dependence on parenteral nutrition.

Management of IBS primarily consists of providing psychological support and recommending dietary measures. No known dietary or lifestyle changes prevent IBD, and no known dietary substances have been consistently shown to cause activation of IBD.

Treatment with antidiarrheal agents such as loperamide or diphenoxylate/atropine should generally be avoided in patients with IBD who have active inflammation, as these drugs can precipitate toxic megacolon in individuals with significant colonic inflammation. The 2014 American College of Gastroenterology monograph on the management of IBS and chronic idiopathic constipation found insufficient evidence to recommend prebiotics or synbiotics, or loperamide, in IBS, and no evidence that polyethylene glycol improved overall symptoms and pain in affected patients.

A stepwise approach (now generally referred to as the step-up approach) may be taken in mild-to-moderate IBD. The first step in medication therapy for IBD is usually aminosalicylates. Step IA is antibiotics, step II is corticosteroids, step III is immunomodulators, and step IV is clinical trial agents.

For more on treatment of IBD, read here.

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