Episode one of two on Irritable Bowel Syndrome and functional bowel, covering positive diagnosis, Rome IV criteria, and subtyping. It maps the brain-gut model and its five mechanisms onto the drug classes. It closes with the mechanism-targeted pharmacology of constipation-predominant IBS. Topics covered Rome IV positive diagnosis IBS subtyping by Bristol form Alarm features and targeted testing IBS-D differential and mimics Brain-gut five-mechanism model Visceral hypersensitivity IBS-C secretagogues Prucalopride prokinetic Key decisions IBS is a positive clinical diagnosis, not exclusion: apply after a brief targeted screen for celiac (tTG plus total IgA), IBD (CRP and calprotectin), and Giardia, not a full rule-out workup. Rome criterion is pain related to defecation (not necessarily improved by it), at least one day a week over three months; subtype by Bristol form on abnormal-BM days only. Abnormal screening tests suspend the IBS label: elevated calprotectin, high CRP, or anemia demands colonoscopy with ileal biopsy and small-bowel imaging; positive tTG with normal IgA is celiac until proven otherwise. Lubiprostone dose split is tested: 8 mcg BID for IBS-C (women), versus 24 mcg BID for chronic idiopathic constipation; give with food to blunt nausea. Linaclotide 290 mcg once daily on an empty stomach at least 30 minutes before the first meal; plecanatide 3 mg with or without food; interchangeable, both boxed warning for dehydration in young children. Prucalopride is a selective 5-HT4 prokinetic (2 mg daily, 1 mg in renal impairment) approved for chronic idiopathic constipation, not IBS-C; designed for cardiac selectivity, the answer for refractory slow-transit constipation after secretagogue failure. For the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com. Questions or feedback: [email protected]. (00:00) - Intro: diagnosis, mechanisms, and IBS-C drugs (00:21) - IBS is a positive diagnosis, not exclusion (01:05) - Rome criteria and Bristol-based subtyping (02:19) - Alarm features and targeted testing (04:17) - IBS-D differential and treatable mimics (05:39) - Brain-gut model and five mechanisms (11:01) - IBS-C general measures and fiber (12:09) - Prescription secretagogues and the prokinetic

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