A 45-year-old woman presents with abdominal discomfort and

A 45-year-old woman presents with abdominal discomfort and

A 45-year-old woman presents with abdominal discomfort and diarrhea. Almost every day, she has variable abdominal discomfort with up to 3 or 4 watery stools. She has associated abdominal bloating and fl atulence. Eating and stress aggravate symptoms, and abdominal discomfort is relieved by defecation. She reports no anorexia, weight loss, or blood in the stool. You suspect irritable bowel syndrome (IBS). Laboratory study results were normal for complete blood cell count, erythrocyte sedimentation rate, and C-reactive protein. Fecal leukocytes are present, but culture for enteric pathogens and testing for Clostridium diffi cile are negative. Which intervention is appropriate at this time? a. Loperamide b. Rifaximin c. Colonoscopy with biopsies d. Reassuring and counseling the patient e. Stool-bulking agents

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