title: Diarrhea-predominant irritable bowel syndrome: Diagnosis, etiology, and new treatment considerations.
abstract: OBJECTIVE
  To provide an overview of irritable bowel syndrome (IBS), specifically the efficacy and tolerability of treatment options for diarrhea-predominant IBS (IBS-D).
  
  
  METHODS
  Research articles available via PubMed were reviewed.
  
  
  CONCLUSIONS
  IBS is a chronic multifactorial disorder that has a negative impact on patient-related quality of life. Genetic factors, psychosociologic factors, alterations in the gut microbiota, and changes in immune, motor, and sensory responses to various stimuli all may be involved in the development of IBS. While pharmacologic therapies for IBS-D have historically been limited (e.g., alosetron), newer therapies (eluxadoline and rifaximin), both approved in the United States in 2015, may be considered for appropriate patients for the management of IBS-D.
  
  
  CONCLUSIONS
  Nurse practitioners play an important role in the diagnosis, care, and management of patients with IBS-D. The goals of therapy should be to reach a correct diagnosis before initiating therapy, provide reassurance to the patient, educate the patient on potential treatment options, improve IBS-D symptoms, minimize risk of harm with treatment, and maximize patient-related quality of life. The authors present a treatment algorithm to guide nurse practitioners on the management of patients with IBS-D.
authors.affiliation: Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Lacy
authors.affiliation: Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Moreau
mesh_terms: D002243:Carbolines / Q000494:pharmacology / Q000627:therapeutic use; D003967:Diarrhea / Q000175:diagnosis / Q000628:therapy; D019468:Disease Management; D006801:Humans; D007093:Imidazoles / Q000494:pharmacology / Q000627:therapeutic use; D043183:Irritable Bowel Syndrome / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy*; D010276:Parasympatholytics / Q000494:pharmacology / Q000627:therapeutic use; D010649:Phenylalanine / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D012294:Rifamycins / Q000494:pharmacology / Q000627:therapeutic use; D000078262:Rifaximin; D014481:United States
chemical_list: D002243:Carbolines; D007093:Imidazoles; D010276:Parasympatholytics; D012294:Rifamycins; C090840:alosetron; C583636:eluxadoline; D010649:Phenylalanine; D000078262:Rifaximin
keywords: Diarrhea; eluxadoline; gastrointestinal; irritable bowel syndrome; microbiota; rifaximin