Abstract
BACKGROUND: Given their emphasis on holistic, patient-centered care, nurse practitioners (NPs) and physician assistants (PAs) play an increasingly critical role in the care of patients with gastrointestinal conditions, including irritable bowel syndrome (IBS).
OBJECTIVES: To review key clinical considerations for the diagnosis and management of IBS, focusing on IBS with diarrhea (IBS-D), alongside 2 case presentations.
DATA SOURCES: PubMed and Google Scholar searches of English-language articles published between January 1, 2009, and April 2, 2025, were conducted to identify publications on the burden, diagnosis, and treatment of IBS-D.
RESULTS: Data indicate that IBS-D impairs quality of life, daily activities, and work productivity and imposes a substantial socioeconomic burden. A positive diagnostic approach involving a detailed medical history and physical examination, with limited laboratory testing in the absence of alarm features, is recommended to facilitate timely and accurate diagnosis. Effective ongoing management relies on a patient-provider relationship that uses shared decision making, patient education and empowerment, and a personalized treatment strategy targeting the IBS subtype and most bothersome symptoms. Treatments considered for IBS-D include dietary management, over-the-counter agents, United States Food and Drug Administration-approved medications, neuromodulators, and gut-brain behavioral therapies.
CONCLUSIONS: Positive diagnosis of IBS-D and an evidence-based, symptom-targeted therapeutic approach are recommended to minimize disease burden.
IMPLICATIONS FOR PRACTICE: Both NPs and PAs are well positioned to provide individualized, compassionate, and competent care to patients with IBS-D. Communicating a confident, positive diagnosis and collaborating on a treatment plan that considers symptom presentation and most bothersome symptoms can improve patient outcomes.