A Biopsychosocial Model of Irritable Bowel Syndrome Pathophysiology - Flowchart
A Biopsychosocial Model of Irritable Bowel Syndrome Pathophysiology - Flowchart Irritable Bowel Syndrome Irritable Bowel Syndrome
«Flowchart»

Chronic or recurrent abdominal pain and erratic bowel disturbance

Chronic or recurrent abdominal pain and erratic bowel disturbance

Chronic or recurrent abdominal pain and erratic bowel disturbance

Tests to make a non-IBS diagnosis
CBC
Routine biochemistry
Celiac serology (tissue transglutaminase antibody, endomysial antibody)
Stool for ova, parasites, and blood
Colonoscopy
Thyroid function
Special tests (depend on symptom pattern)

Tests to make a non-IBS diagnosis
CBC
Routine biochemistry
Celiac serology (tissue transglutaminase antibody, endomysial antibody)
Stool for ova, parasites, and blood
Colonoscopy
Thyroid function
Special tests (depend on symptom pattern)

Tests to make a non-IBS diagnosis






Tests to make a non-IBS diagnosis

Positive history for IBS: make a positive diagnosis

Positive history for IBS: make a positive diagnosis

Positive history for IBS

End

End

End

No further treatment
Follow-up

No further treatment
Follow-up

No further treatment
Follow-up


Treat comorbid psychiatric disease, e.g., depression
Antidepressants

Treat comorbid psychiatric disease, e.g., depression
Antidepressants

Treat comorbid psychiatric disease, e.g., depression
Antidepressants


Fiber/liquids/exercise
Lubiprostone
Linaclotide
Probiotics
Tegaserod
Osmotic laxatives

Fiber/liquids/exercise
Lubiprostone
Linaclotide
Probiotics
Tegaserod
Osmotic laxatives

Fiber/liquids/exercise
Lubiprostone
Linaclotide
Probiotics
Tegaserod
Osmotic laxatives






Anticholinergics
Antidepressants (low dose initially)
Pain clinic

Anticholinergics
Antidepressants (low dose initially)
Pain clinic

Anticholinergics
Antidepressants (low dose initially)
Pain clinic



Rifamixin
Eluxadoline
Alosetron
Loperamide
Cholestyramine
Tricyclic antidepressants

Rifamixin
Eluxadoline
Alosetron
Loperamide
Cholestyramine
Tricyclic antidepressants

Rifamixin
Eluxadoline
Alosetron
Loperamide
Cholestyramine
Tricyclic antidepressants






Target drugs to specific complaints

Target drugs to specific complaints

Target drugs to specific complaints

Pain

Pain

Pain

Constipation

Constipation

Constipation

Diarrhea

Diarrhea

Diarrhea

Reassurance
Education
Diet/fiber supplements
Support

Reassurance
Education
Diet/fiber supplements
Support

Reassurance
Education
Diet/fiber supplements
Support




Mildly troubled

Mildly troubled

Mildly troubled

Persistent specific complaints

Persistent specific complaints

Persistent specific complaints

Psychiatric component
Difficult

Psychiatric component
Difficult


Psychiatric component

cGMP, Cyclic guanosine monophosphate; 5-HT3, serotonin type 3; 5-HT4, serotonin type 4; FODMAPs, fermentable oligosaccharides, disaccharides, monosaccharides, and polyols; HRQOL, health-related quality of life; IBS, irritable bowel syndrome.

cGMP, Cyclic guanosine monophosphate; 5-HT3, serotonin type 3; 5-HT4, serotonin type 4; FODMAPs, fermentable oligosaccharides, disaccharides, monosaccharides, and polyols; HRQOL, health-related quality of life; IBS, irritable bowel syndrome.

cGMP, Cyclic guanosine monophosphate; 5-HT3, serotonin type 3; 5-HT4, serotonin type 4; FODMAPs, fermentable oligosaccharides, disaccharides, monosaccharides, and polyols; HRQOL, health-related quality of life; IBS, irritable bowel syndrome.

cGMP 5-HT3 5-HT4 FODMAPs HRQOL IBS

Normal tests and symptoms persist

Normal tests and symptoms persist

Normal tests

Exclude:


Colorectal cancer
Inflammatory bowel disease
Metabolic disease

Exclude:

Exclude:


Colorectal cancer
Inflammatory bowel disease
Metabolic disease


Colorectal cancer
Inflammatory bowel disease
Metabolic disease Exclude