Diagnosis and treatment of irritable bowel syndrome with diarrhea: Key clinical considerations

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).

To review key clinical considerations for the diagnosis and management of IBS, focusing on IBS with diarrhea (IBS-D), alongside 2 case presentations.

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.

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.

Positive diagnosis of IBS-D and an evidence-based, symptom-targeted therapeutic approach are recommended to minimize disease burden.

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.