New guidance, treatments for IBS

This month's issue addresses irritable bowel syndrome (IBS), bereavement among patients, and transgender care.

With great strides in research over the past several decades, patients with irritable bowel syndrome (IBS) now have many more treatments available. New guidelines from the American College of Gastroenterology and the American Gastroenterological Association offer detailed road maps on drugs, diet, and other ways to ease IBS symptoms. But don't overlook the value of listening to the patient, said experts who talked to Senior Writer Mollie Frost for this issue. Once called "nervous colitis," IBS is now considered a disorder of gut-brain interaction, and a physician taking symptoms seriously can be the first step toward healing.

Do you ask your elderly patients about recent losses in their lives? If you don't, you're not alone; a 2018 survey found that only 33% of physicians regularly screen for this information. But while grief may not be part of the typical differential diagnosis, it can have lasting implications for a patient's health, including increased difficulty making their own care decisions. Our story reviews how to talk to patients after a loss and offers tips for diagnosing and managing prolonged grief disorder.

Transgender patients need specific screening and care, but studies show they are unlikely to get it, in large part because their physicians don't know—or don't care—how to provide it. In the U.S. Transgender Survey, conducted in 2015, one-third of respondents reported at least one negative experience with a clinician in the past year because they were transgender, and nearly a quarter said they avoided care out of fear of being mistreated. Primary care physicians can help change these statistics by providing gender-affirming care, creating a welcoming environment, and learning how to tailor preventive care. Turn to our story for more.

Also in this issue, hear from two ACP members who joined a June 2022 tour of U.S. Customs and Border Protection facilities near the Texas/Mexico border, where people seeking asylum in the U.S. are held for up to three days. Ruth Berggren, MD, MACP, and Elena Jiménez Gutiérrez, MD, MSc, FACP, recently spoke to ACP Internist about why they made this visit, what they saw at the facilities, and how ACP and its members can participate in working toward improvements.

Finally, in our first Pearls from I.M. Peers column of 2023, Joel Diamant, MD, MACP, explains three physical exam pearls for patients with pain. Do you have an idea for a pearl to share, or an expert diagnostician you think we should interview? Please let us know at I wish all our readers a healthy and happy new year.


Jennifer Kearney-Strouse
Executive Editor