The answer is C. High-fiber diet and adequate hydration
The patient’s symptoms are consistent with irritable bowel syndrome (IBS), characterized by recurrent abdominal discomfort or pain related to defecation and associated with a change in the frequency or consistency of stool. The absence of “red flag” symptoms (such as weight loss, rectal bleeding, or family history of gastrointestinal cancers) suggests a lower likelihood of a serious underlying condition. Initial management of IBS, particularly in the absence of red flags, often includes lifestyle modifications such as a high-fiber diet and adequate hydration. These changes can help regulate bowel movements and alleviate symptoms in many patients with IBS.
Explanation for Incorrect Answers:
A. Colonoscopy: While important for excluding other pathologies in patients with red flag symptoms or those over the age of 45, immediate colonoscopy is not typically required in younger patients presenting with classic IBS symptoms and no red flags.
B. Lactose-free diet: While dietary modifications can be beneficial in IBS, there is no indication in this patient’s history to suggest lactose intolerance. A lactose-free diet is more specifically indicated when patients report symptoms consistent with lactose intolerance.
D. Antidepressant therapy: Antidepressants, particularly tricyclic antidepressants, can be used in IBS to manage pain and bowel symptoms, especially in patients with IBS-D (diarrhea predominant) or those with significant psychological distress. However, they are not typically first-line for initial management in the absence of significant psychological symptoms.
E. Empirical antibiotic therapy: Antibiotics, such as rifaximin, may be used in specific cases of IBS, particularly IBS-D, but are not considered first-line treatment and are not indicated without evidence of bacterial overgrowth or specific infection.
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