The Question
A 28-year-old woman comes to the office to discuss management of chronic abdominal symptoms. For the past two years, she has experienced crampy lower abdominal pain, bloating, and a sensation of incomplete evacuation. The pain is typically relieved with defecation. Her bowel habits fluctuate between periods of hard, pellet-like stools and loose, watery stools, with each pattern lasting for several weeks at a time. These symptoms occur 3 to 4 days per week and are causing her significant distress. She has not experienced weight loss, rectal bleeding, or nocturnal symptoms. Her physical examination is unremarkable. Vitals are normal. Laboratory studies, including a complete blood count, comprehensive metabolic panel, thyroid-stimulating hormone, and tissue transglutaminase IgA antibody, are all within normal limits. A fecal calprotectin level is also normal. Which of the following is the most appropriate next step in management?
See the answer and explanation below:
Post-Call Recovery Reads
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View on AmazonThe Correct Answer
A
Explanation
Clinical Pearl:
For patients with irritable bowel syndrome (IBS) characterized by prominent abdominal pain, low-dose tricyclic antidepressants (TCAs) serve as a first-line therapy. They function as central neuromodulators to reduce visceral hypersensitivity, independent of their antidepressant effects.
Explanation:
Gastroenterology and Hepatology
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