US FDA approves tenapanor for the treatment of constipation-predominant IBS
The US Food and Drug Administration (FDA) has approved tenapanor for the treatment of irritable bowel syndrome with constipation (IBS-C) in adults. Tenapanor inhibits gastrointestinal sodium/hydrogen exchanger 3, reducing re-absorption of sodium from the small intestine and colon, which increases water secretion into the intestinal lumen and softens the stool.
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Irritable bowel syndrome symptoms include recurrent abdominal pain or discomfort that is associated with a change in stool frequency or form. The pain or discomfort may be relieved by defecation.
It is important to determine whether there are any potential precipitating dietary associations such as caffeine, lactose-containing foods, or fructose-containing foods.
Examination of the abdomen is usually unremarkable. There may be mild and poorly localised tenderness in the right lower quadrant and/or left lower quadrant.
The diagnosis is based on the patient's history; there are no specific diagnostic tests. If the patient has worrying symptoms or findings such as anaemia, weight loss, or fever, then these require thorough investigation.
Treatment should be individualised and is dependent on the patient's predominant symptoms.
Irritable bowel syndrome (IBS) is a chronic condition characterised by abdominal pain associated with bowel dysfunction. The pain is often relieved by defecation and is sometimes accompanied by abdominal bloating. There are no structural abnormalities to explain the pain. IBS occurs in about 15% of the adult population. The aetiology is probably multi-factorial and evidence suggests motility, inflammatory, genetic, immune, psychological, and dietary components.
History and exam
- fecal occult blood test
- serologic tests for celiac disease
- faecal calprotectin
- fecal lactoferrin
- serum CRP
- 48-hour stool collection for total bile acids
- serum fibroblast growth factor 19
- 23‐seleno‐25‐homotaurocholic acid (SeHCAT) test
- empiric trial of bile acid binder
- hydrogen breath test
- stool tests for Giardia lamblia
- plain abdominal x-ray
- flexible sigmoidoscopy
Chief of Gastroenterology and Hepatology
Clinical Professor of Medicine
Baylor College of Medicine
Adjunct Professor of Medicine
University of Texas Medical Branch
NS declares that he has no competing interests.
Professor of Medicine and Psychiatry
School of Medicine
UNC Center for Functional GI and Motility Disorders
DD declares that he has no competing interests.
Department of Gastroenterology
St Mark's Hospital
SM declares that he has no competing interests.
Clinical Research Fellow
Division of Medicine
HW declares that he has no competing interests.
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