Show notes
Irritable bowel syndrome (IBS) is one of the most common—and often frustrating—conditions seen in primary care. Patients may come in with chronic abdominal pain, diarrhea, constipation, bloating, or a mix of symptoms, and many have already been told that their testing is “normal.” So how do you confidently evaluate IBS, rule out more serious conditions, and help patients move forward?In this episode, Liz talks with neurogastroenterologist Dr. Zach Spiritos about the real-world approach to IBS, including the underlying pathophysiology, common diagnostic pitfalls, practical workup strategies, and treatment options that go far beyond medication alone.Whether you're a new NP or an experienced clinician, this episode offers practical strategies to help you approach IBS with greater confidence and compassion.Timestamps:00:00 - Introduction to Dr. Zach Spiritos and episode overview02:16 - Pathway into neuro gastroenterology and training background05:06 - What is IBS? Symptoms, diagnosis, and underlying mechanisms07:36 - Factors contributing to IBS: trauma, antibiotics, triggers09:21 - Differential diagnosis: celiac, SIBO, bile acid malabsorption11:54 - When to consider endoscopy and testing strategies14:35 - History-taking tips for primary care clinicians17:54 - Managing expectations in chronic GI conditions20:12 - Overuse of endoscopy and its limited findings22:08 - Understanding what endoscopy can actually reveal24:23 - Communicating with patients who have “all tests normal”27:40 - The multitude of IBS treatment approaches: diet, psychological, medication32:12 - Role of diet and FODMAP in symptom management35:10 - Pharmacological options for IBSC and IBSD39:06 - Medications overview: Linzess, Amitiza, Viberzi, and others44:04 - The role and limitations of probiotics and fiber45:08 - Tips on managing patient expectations and chronicity46:54 - Setting goals and tracking progress with patients48:16 - Final advice: empower patients with knowledge, manage expectations, and tailor treatmentsFor a full transcript and conversation chapters, visit the blog www.realworldnp.com/blog/ibs______________________________© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.