Date of Award

Spring 2022

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Samantha Creamer

Abstract

Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder characterized by a relapsing-remitting course of abdominal discomfort and change in stool form and/or frequency in the absence of any structural or biochemical abnormalities. Currently there is debate on its pathogenesis but there is no definitive conclusion. Treatment consists of primarily playing symptomalogic catch-up with anti-spasmodics, anti-diarrheals, stool softeners, or laxatives depending on which symptoms the patient is currently experiencing. Patients with IBS typically struggle to control their symptoms long term, like the patient described in this case study. This case study explores a possible link between IBS and its’ most commonly seen comorbidity – anxiety. There is evidence supporting a dysregulation of the brain-gut axis in IBS patients with concomitant generalized anxiety, specifically an imbalance in the neurotransmitter serotonin (5-HT). Regulating the balance of 5-HT via selective serotonin reuptake inhibitors (SSRIs) is seen as the first line treatment of generalized anxiety, with tri-cyclic antidepressants being another option used in these patients. In theory, these medications could help regulate the balance of 5-HT in IBS patients as well. Whether this would be a successful treatment has yet to be determined. Further research is needed to determine whether tighter regulation of 5-HT in IBS patients with GAD could provide better long-term symptomatic improvement.

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Capstone Presentation - Stephen Driscoll.pdf (365 kB)

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A Case of Irritable Bowel Syndrome in the Setting of Generalized Anxiety Disorder

Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder characterized by a relapsing-remitting course of abdominal discomfort and change in stool form and/or frequency in the absence of any structural or biochemical abnormalities. Currently there is debate on its pathogenesis but there is no definitive conclusion. Treatment consists of primarily playing symptomalogic catch-up with anti-spasmodics, anti-diarrheals, stool softeners, or laxatives depending on which symptoms the patient is currently experiencing. Patients with IBS typically struggle to control their symptoms long term, like the patient described in this case study. This case study explores a possible link between IBS and its’ most commonly seen comorbidity – anxiety. There is evidence supporting a dysregulation of the brain-gut axis in IBS patients with concomitant generalized anxiety, specifically an imbalance in the neurotransmitter serotonin (5-HT). Regulating the balance of 5-HT via selective serotonin reuptake inhibitors (SSRIs) is seen as the first line treatment of generalized anxiety, with tri-cyclic antidepressants being another option used in these patients. In theory, these medications could help regulate the balance of 5-HT in IBS patients as well. Whether this would be a successful treatment has yet to be determined. Further research is needed to determine whether tighter regulation of 5-HT in IBS patients with GAD could provide better long-term symptomatic improvement.