Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 167: A 23-Year-Old with Abdominal Pain and Diarrhea
Oct 9, 2025
Dive into a compelling case of a 23-year-old experiencing chronic abdominal pain and diarrhea. The hosts analyze the nuances of her symptoms, discuss the complexities of diagnosing IBS, and outline the critical features to consider. Explore various management options, from dietary interventions like the low-FODMAP diet to medications such as loperamide and eluxadoline. The conversation also highlights red flags to rule out other conditions and the importance of individualized treatment approaches.
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IBS Is A Symptom-Driven Diagnosis
- Irritable bowel syndrome (IBS) is a clinical diagnosis based on symptoms, not biomarkers.
- The Rome IV criteria require recurrent abdominal pain ≥1 day/week for 3 months plus two related features.
IBS Subtypes Are Fluid And Symptom-Based
- IBS subtypes include predominant constipation, predominant diarrhea, or mixed patterns that often change over time.
- Diarrheal IBS typically causes small-volume loose stools, urgency, mucus, and sometimes incontinence.
IBS Likely Has Multiple Interacting Causes
- IBS pathogenesis remains poorly understood and likely involves multiple interacting factors.
- Proposed contributors include gut motility, central neural dysfunction, inflammation, bile acid issues, and dysbiosis.
