1. Dysregulation of which of the following bilateral communication pathways contributes to the chronic abdominal pain and altered bowel habits that are characteristics of irritable bowel syndrome (IBS)?
A. Gut-bowel axis
B. Gut-microbiota axis
C. Gut-brain axis
D. Gut-abdominal axis
E. Unsure
2. Although the exact cause of IBS is unknown, which one of the following may lead to IBS symptoms?
A. Acute stress (<6 months)
B. Bacterial enteric infections
C. Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet
D. Soluble fiber
E. Unsure
3. One survey of nearly 2000 adults with IBS found that patients with IBS, in general, were willing to give up approximately what percent of their remaining years to receive a new and effective IBS treatment that would make them symptom-free?
A. 5% of their remaining years
B. 10% of their remaining years
C. 15% of their remaining years
D. 25% of their remaining years
E. Unsure
4. Which one of the following US Food and Drug Administration (FDA)-approved IBS with constipation (IBS-C) prescription medications was voluntarily withdrawn from the US market in June 2022 and will no longer be available after existing supplies are depleted?
A. Tegaserod
B. Lubiprostone
C. Linaclotide
D. Plecanatide
E. Unsure
5. When evaluating medications for the treatment of IBS-C, the most recent FDA guidance on regulatory IBS efficacy endpoints recommends which of the following primary endpoints?
A. Weekly improvements in abdominal pain only
B. Daily changes in the number of complete spontaneous bowel movements (CSBMs) only
C. Daily improvements in abdominal pain only
D. Daily improvements in abdominal pain AND weekly changes in the number of CSBMs
E. Unsure
6. Use this CASE to answer questions 6-9 below.
A. Yes, her symptom duration is consistent with a diagnosis of IBS-C
B. No, her symptom duration is not consistent with a diagnosis of IBS-C
C. No, her bowel movements are not consistent with IBS-C
D. No, her abdominal pain is relieved after she has a bowel movement which is not consistent with IBS-C
E. Unsure
7. KL tells you she would like to learn about nonpharmacologic treatment options before starting any pharmacotherapy. All of the following nonpharmacologic treatment options are recommended in the ACG IBS guidelines, except:
A. Soluble fiber in doses up to 35 g/d (with gradual dose escalation)
B. Probiotics
C. Low FODMAP diet (limited trial of 4 weeks)
D. Peppermint oil (enteric-coated formulation)
E. Unsure
8. KL tells you she could not tolerate soluble fiber due to bloating or peppermint oil due to acid reflux. Also, the low FODMAP diet was too expensive. She is interested in starting a prescription medication as her symptoms negatively impact her quality of life. Which of the following FDA-approved secretagogues is a first-in-class, small-molecule inhibitor of GI sodium-hydrogen ion-exchange isoform-3 (NHE3) receptor?
A. Linaclotide
B. Lubiprostone
C. Tenapanor
D. Plecanatide
E. Unsure
9. KL asks you if any FDA-approved IBS-C medications are available as a generic medication. Which of the following is the correct answer to KL's question?
A. Yes, lubiprostone is available as a generic medication
B. Yes, linaclotide is available as a generic medication
C. Yes, plecanatide is available as a generic medication
D. No, there are no generic medications
E. Unsure
10. All the following are important considerations when dispensing tenapanor, except:
A. Tenapanor should be taken twice a day, immediately before breakfast or the first meal of the day and immediately before dinner
B. Diarrhea was the most common adverse event reported during the clinical trials and if severe, treatment should be stopped until the patient is rehydrated
C. Tenapanor is only approved to treat women with IBS-C
D. Tenapanor is contraindicated in children aged younger than 6 years and in patients with known or suspected mechanical GI obstruction
E. Unsure
Evaluation Questions
11. How confident are you in your treatment choices for KL in questions 6-9?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident
