American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the first-line therapy for irritable bowel syndrome with constipation?

1. Lifestyle modifications

2. Linaclotide

3. Probiotics

4. Fiber supplement

The correct answer is: Lifestyle modifications

The rationale for selecting lifestyle modifications as the first-line therapy for irritable bowel syndrome (IBS) with constipation lies in their foundational role in managing this condition. Lifestyle modifications typically encompass dietary changes, increased physical activity, stress management techniques, and establishing regular bowel habits. These approaches can help alleviate symptoms by improving bowel function and enhancing overall digestive health. Dietary adjustments often include increasing fiber intake through food sources, staying adequately hydrated, and avoiding specific foods that may trigger symptoms. Physical activity is known to foster regular bowel movements and improve gastrointestinal motility, while stress management can address one of the key psychological components associated with IBS. While other options such as linaclotide, probiotics, and fiber supplements can be beneficial adjuncts or alternatives depending on the patient's specific situation, they are generally not considered the initial step in managing IBS with constipation. This therapeutic hierarchy underscores the importance of starting with more conservative, holistic approaches before progressing to pharmacological treatments. Consequently, lifestyle modifications serve as a foundational strategy that addresses multiple aspects of the syndrome, promoting long-term management of symptoms and enhancing quality of life.