Which is the most appropriate in the treatment of this patient’s symptoms? A 28-year-old woman has a 1-year history of recurrent abdominal pain relieved by defecation. She reports that her diarrhea has gotten worse in the last 2 weeks, since she started a new job. Her examination is unremarkable except for mild abdominal tenderness. Laboratory studies show:Hemoglobin:     13.0 g/dLHematocrit:            39%WBC count:        6000/mm³Platelet count:    200,000/mm³Erythrocyte sedimentation rate: 8 mm/h

Loperamide

The correct answer is C. This young woman has irritable bowel syndrome (IBS). IBS, a diagnosis of exclusion, is an idiopathic functional disorder characterized by abdominal pain and changes in bowel habits that increase with stress (e.g., starting a new job) and are relieved with bowel movements. A normal complete blood count, erythrocyte sedimentation rate, and physical exam are consistent with this benign disease. Most people with this condition need reassurance from their physicians. However, pharmacologic treatment with antidiarrheals such as loperamide (an opioid) may be used in patients with diarrhea-predominant IBS Answer A is incorrect. Bactrim (trimethoprimsulfamethoxazole) is an antibiotic used to treat conditions of infectious origin. Bactrim is not used for the treatment of IBS Answer B is incorrect. Bismuth is an agent used in peptic ulcers. This drug binds to the ulcer base, providing physical protection from acid. It has no clinical use in IBS Answer D is incorrect. Metronidazole is an antibiotic that is effective against anaerobes, protozoans, and gram-negative bacteria. It has no role in IBS treatment Answer E is incorrect. Octreotide, a somatostatin analog, may be useful in carcinoid syndrome and acromegaly. It has no known benefit in IBS treatment Answer F is incorrect. Omeprazole is a proton pump inhibitor that is useful in therapy for gastroesophageal reflux disease, gastritis, and peptic ulcer disease. It has no use in treatment of IBS.