American Board of Internal Medicine (ABIM) Certification Practice Exam

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What is the first-line treatment for irritable bowel syndrome with diarrhea?

Loperamide
Rifaximin
Probiotics
Dietary modifications

The correct answer is: Rifaximin

The first-line treatment for irritable bowel syndrome with diarrhea (IBS-D) is generally considered to be dietary modifications. This approach focuses on managing symptoms through changes in the patient's eating habits, which can help reduce symptoms such as bloating, gas, and diarrhea. For many patients, adjusting fiber intake, avoiding specific trigger foods, and implementing a low FODMAP diet can significantly improve their condition. While certain medications like rifaximin can assist specific symptom management and loperamide may be used for acute diarrhea relief, they are not typically seen as first-line therapies. Probiotics can also play a role in promoting gut health but are not classified as a primary treatment for IBS-D. Thus, focusing on dietary modifications is essential in the comprehensive management of this syndrome.