From the Guidelines
Treatment for Irritable Bowel Syndrome (IBS) should start with dietary adjustments, including a low-FODMAP diet for 4-6 weeks, followed by a systematic reintroduction phase to identify personal triggers, as recommended by the British Society of Gastroenterology guidelines 1. The goal of treatment is to alleviate symptoms, improve quality of life, and reduce morbidity and mortality.
- Key components of treatment include:
- Dietary changes: a low-FODMAP diet, soluble fiber supplements like ispaghula, and avoidance of insoluble fiber like wheat bran 1
- Medications: loperamide for diarrhea, antispasmodics like dicyclomine, and antidepressants like amitriptyline for pain management 1
- Lifestyle modifications: regular exercise, stress management techniques like meditation, and adequate sleep 1
- A personalized approach is essential, and treatment may require trying different combinations to find what works best for individual symptoms.
- It is also important to address mental health comorbidities, such as anxiety and depression, which are common in IBS patients, through integrated care models that include medical management, dietary modifications, and psychological therapy 1.
- The most recent and highest quality study, published in 2021 by the British Society of Gastroenterology, provides strong recommendations for the management of IBS, including dietary advice, medication, and lifestyle modifications 1.
From the FDA Drug Label
LINZESS is a guanylate cyclase-C agonist indicated for treatment of: Irritable bowel syndrome with constipation (IBS-C) in adults. Lubiprostone is indicated for the treatment of irritable bowel syndrome with constipation (IBS-C) in women at least 18 years old.
IBS Treatment Options:
- Linaclotide (PO) is indicated for the treatment of Irritable Bowel Syndrome with Constipation (IBS-C) in adults 2.
- Lubiprostone (PO) is indicated for the treatment of Irritable Bowel Syndrome with Constipation (IBS-C) in women at least 18 years old 3.
From the Research
IBS Treatment Options
- Current therapeutic options for irritable bowel syndrome (IBS) include lifestyle modifications, over-the-counter (OTC) agents, antispasmodics, serotonin agonists, and prosecretory prescription drugs such as lubiprostone and linaclotide 4.
- For IBS with constipation (IBS-C), OTC laxatives may relieve constipation but do not treat abdominal pain and discomfort, while antispasmodics may provide short-term relief but have limited utility due to anticholinergic adverse effects 4.
- Tricyclic antidepressants, selective serotonin reuptake inhibitors, and serotonin-norepinephrine reuptake inhibitors have shown benefit in providing global symptom relief and improving abdominal discomfort in IBS-C patients 4.
Emerging Therapies
- Emerging potential treatment options for IBS-C include prucalopride, plecanatide, elobixibat, and tenapanor, which have novel mechanisms of action and may show promise in patients who have not responded to other therapies 4.
- For IBS with diarrhea (IBS-D), current pharmacological treatment options include loperamide, bile acid sequestrants, antispasmodics, tricyclic antidepressants, alosetron, eluxadoline, and rifaximin 5.
- Rifaximin and eluxadoline have significantly added to the pharmacotherapeutic options for patients suffering from IBS-D 5.
Safety and Efficacy
- Lubiprostone was found to be safe with insignificant harm in one combined phase III trial, while selective serotonin reuptake inhibitors seemed to be safe but lacked enough data for a reliable meta-analysis of harm 6.
- Tricyclic antidepressants and alosetron were associated with a significant number needed to harm compared to rifaximin, with adverse events occurring more commonly with these treatments 6.
- The numbers needed to harm were 18.3,19.4, and 8971 for tricyclic antidepressants, alosetron, and rifaximin, respectively, highlighting the importance of considering side effects when selecting a treatment for IBS 6.