ROSH Gastrointestinal Practice Exam

For a 25-year-old woman experiencing abdominal pain and constipation with normal test results, what is the most appropriate next step in management?

1. Cholestyramine

2. Loperamide

3. Polyethylene glycol

4. Rifaximin

The correct answer is: Polyethylene glycol

In this case, the woman is experiencing abdominal pain and constipation, and she has already undergone testing that yielded normal results. The presence of constipation, especially in the context of normal evaluations, suggests that non-pharmacological approaches or osmotic laxatives may be the most effective and appropriate next step in managing her symptoms. Polyethylene glycol (PEG) is an osmotic laxative that works by attracting water into the bowel, which helps to soften stools and promote bowel movements. It is generally considered a first-line treatment for constipation, particularly in functional disorders, as it is effective, safe, and well-tolerated in the long term. Additionally, if the constipation is contributing to abdominal pain, addressing the constipation with PEG could help alleviate her overall discomfort. Other options, like cholestyramine, loperamide, and rifaximin, are used for different conditions and may not address her specific symptoms effectively. Cholestyramine is typically used for bile acid diarrhea or to lower cholesterol, loperamide is an anti-diarrheal that would not be suitable for a patient with constipation, and rifaximin is an antibiotic primarily prescribed for certain gastrointestinal infections or conditions like IBS-D. These options do not target the constipation that is central to her presentation