From the Guidelines
Evidence-based management of irritable bowel syndrome (IBS) and functional dyspepsia should prioritize a step-wise approach, starting with lifestyle modifications such as regular exercise and dietary changes, including a low-FODMAP diet, before adding medications. For IBS, first-line pharmacologic treatments include antispasmodics like dicyclomine or hyoscyamine for pain, loperamide for diarrhea-predominant IBS, and osmotic laxatives like polyethylene glycol for constipation-predominant IBS, as recommended by the British Society of Gastroenterology guidelines 1. Non-pharmacologic strategies for both conditions include stress management techniques like cognitive behavioral therapy, gut-directed hypnotherapy, or mindfulness-based stress reduction, which has been shown to reduce IBS symptoms by replacing maladaptive thinking with non-judgemental observations 1.
Some key points to consider in the management of IBS and functional dyspepsia include:
- Dietary modifications, such as a low-FODMAP diet, can be effective in managing global symptoms and abdominal pain in IBS, but should be supervised by a trained dietitian 1
- Probiotics may be an effective treatment for global symptoms and abdominal pain in IBS, but the evidence is limited and it is not possible to recommend a specific species or strain 1
- Mindfulness-based stress reduction can be a useful adjunct to other therapies, and can be safely incorporated into practice by non-mental-health professionals 1
- A stepwise approach to rule-out ongoing inflammatory activity should be followed in patients with inflammatory bowel disease (IBD) and persistent GI symptoms, and alternative pathophysiologic mechanisms should be considered and evaluated based on predominant symptom patterns 1
The most effective approach will depend on the individual patient's symptoms and needs, and should be tailored to address the gut-brain interaction, reduce visceral hypersensitivity, normalize gut motility, and decrease inflammation. Treatment should be individualized, with a step-wise approach starting with lifestyle modifications before adding medications, and considering the use of psychological therapies such as cognitive behavioral therapy or hypnotherapy for patients with functional symptoms 1.
From the Research
Nonpharmacologic Management
- A low-FODMAP diet has been shown to be effective in managing irritable bowel syndrome (IBS) symptoms, with 52-86% of patients reporting significant improvement 2.
- The low-FODMAP diet can also be beneficial for patients with functional dyspepsia, particularly those with postprandial distress syndrome 3.
- A structured reintroduction of foods containing individual FODMAPs can help determine sensitivities and allow for personalization of the diet plan 2.
- Lifestyle adaptations, such as stress management and regular exercise, can also be beneficial in managing IBS and functional dyspepsia symptoms 4.
Pharmacologic Management
- Pharmacological therapy, such as oral omeprazole and domperidone, can be used in conjunction with a low-FODMAP diet to manage IBS and functional dyspepsia symptoms 3.
- Proton pump inhibitors (PPIs) and prokinetics can be used to treat functional dyspepsia symptoms, while antispasmodics, secretagogues, laxatives, bile acid sequestrants, antidiarrheals, and antibiotics can be used to treat IBS symptoms 4.
- Visceral analgesics, such as antidepressants, can be used to treat global IBS symptoms 5.
- Chloride channel activators and guanylate cyclase activators can be used to treat IBS with constipation symptoms, while rifaximin can be used to treat IBS with diarrhea symptoms 5.