Irritable bowel syndrome (IBS) is one of the most common—and often frustrating—conditions seen in primary care. Patients may come in with chronic abdominal pain, diarrhea, constipation, bloating, or a mix of symptoms, and many have already been told that their testing is “normal.” So how do you confidently evaluate IBS, rule out more serious conditions, and help patients move forward?
In this episode, Liz talks with neurogastroenterologist Dr. Zach Spiritos about the real-world approach to IBS, including the underlying pathophysiology, common diagnostic pitfalls, practical workup strategies, and treatment options that go far beyond medication alone.
Whether you're a new NP or an experienced clinician, this episode offers practical strategies to help you approach IBS with greater confidence and compassion.
Timestamps:
00:00 - Introduction to Dr. Zach Spiritos and episode overview
02:16 - Pathway into neuro gastroenterology and training background
05:06 - What is IBS? Symptoms, diagnosis, and underlying mechanisms
07:36 - Factors contributing to IBS: trauma, antibiotics, triggers
09:21 - Differential diagnosis: celiac, SIBO, bile acid malabsorption
11:54 - When to consider endoscopy and testing strategies
14:35 - History-taking tips for primary care clinicians
17:54 - Managing expectations in chronic GI conditions
20:12 - Overuse of endoscopy and its limited findings
22:08 - Understanding what endoscopy can actually reveal
24:23 - Communicating with patients who have “all tests normal”
27:40 - The multitude of IBS treatment approaches: diet, psychological, medication
32:12 - Role of diet and FODMAP in symptom management
35:10 - Pharmacological options for IBSC and IBSD
39:06 - Medications overview: Linzess, Amitiza, Viberzi, and others
44:04 - The role and limitations of probiotics and fiber
45:08 - Tips on managing patient expectations and chronicity
46:54 - Setting goals and tracking progress with patients
48:16 - Final advice: empower patients with knowledge, manage expectations, and tailor treatments
For a full transcript and conversation chapters, visit the blog www.realworldnp.com/blog/ibs
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