Alosetron for severe diarrhea-predominant irritable bowel syndrome: improving patient outcomes.

Background: Irritable bowel syndrome (IBS) is a common gastrointestinal disorder often diagnosed and managed by primary care physicians (PCPs). Despite the high prevalence of IBS, symptom severity is often underappreciated and inadequately managed. The goal of this review is to discern IBS treatment gaps and identify opportunities for improving its management in the primary care setting, as well as describe the most current clinical experience with alosetron, a targeted treatment for severe diarrhea-predominant IBS (IBS-D) in women.

Chronic constipation: let symptom type and severity direct treatment.

Increased fiber intake through diet or fiber supplements is an appropriate initial therapy for chronic constipation. Osmotic and stimulant laxatives may be administered to patients who do not respond to more conservative measures if the limitations of these agents are explained. Tegaserod, a selective 5-hydroxytryptamine type 4 (5-HT4) receptor partial agonist, is more effective than placebo at relieving symptoms of chronic idiopathic constipation in patients younger than 65 years of age.

Practical symptom-based evaluation of chronic constipation.

A symptom-based approach is the best means for diagnosing chronic constipation. Extensive diagnostic testing is seldom necessary unless alarm features are present. Encourage routine colon cancer screening tests for all patients aged 50 years or older.