From the Guidelines
The best treatment for IBS mixed subtype typically involves a combination approach targeting both diarrhea and constipation symptoms, starting with lifestyle modifications and dietary changes, as recommended by the British Society of Gastroenterology guidelines 1. The treatment approach should prioritize soluble fiber supplements, such as ispaghula, at a low dose of 3-4 g/day, which can help regulate bowel movements and alleviate abdominal pain 1.
- Key lifestyle modifications include:
- Regular exercise
- Stress management techniques like meditation or yoga
- Adequate sleep
- Dietary changes are crucial, with a focus on:
- A low-FODMAP diet for 4-6 weeks, followed by systematic reintroduction of foods to identify triggers
- Avoiding insoluble fiber, such as wheat bran, which may exacerbate symptoms 1 For medication, loperamide may be an effective treatment for diarrhea in IBS, but its use should be carefully titrated to avoid common side effects like abdominal pain, bloating, nausea, and constipation 1. Additional treatment options may include:
- Antispasmodics, such as certain antispasmodic drugs, which may be effective for global symptoms and abdominal pain in IBS, although they can have common side effects like dry mouth, visual disturbance, and dizziness 1
- Psychological therapies, such as IBS-specific cognitive behavioral therapy or gut-directed hypnotherapy, which may be considered when symptoms have not improved after 12 months of drug treatment, or earlier if accessible locally and based on patient preference 1 Treatment should be individualized based on predominant symptoms and adjusted as needed, with a focus on addressing the gut-brain connection, normalizing intestinal motility, reducing visceral hypersensitivity, and balancing gut microbiota.
From the Research
Treatment Options for IBS Mixed Subtype
The treatment of IBS mixed subtype (IBS-M) involves a multidisciplinary approach, including primary care, gastroenterologist, and psychologist 2. Some key treatment options include:
- Dietary modification, which is often the first line of therapy 2
- Lifestyle treatments, such as complementary alternative medications (CAM), probiotics, and peppermint oil, which can be useful adjuncts 2
- Psychotherapy, which has strong evidence to support its use in the treatment of IBS 2, 3
- Pharmacological treatments, such as:
- Anti-diarrheals and anti-spasmodics for symptom management 3
- Anti-depressants, such as tricyclic antidepressants and selective serotonin reuptake inhibitors, which can provide global symptom relief and improve abdominal pain 3, 4
- FDA-approved medications, such as rifaximin, eluxadoline, and alosetron, which can be effective in treating IBS-D and IBS-M 2, 5
Emerging Therapies
There are several emerging therapies that may be effective in treating IBS-M, including:
- Faecal microbial transplant 2
- Crofelemer and serotonin antagonists, which may have potential benefits in improving global IBS symptoms 2
- Prosecretory agents, such as lubiprostone and linaclotide, which can improve stool frequency and abdominal pain in patients with IBS-C and CIC 6
- Novel mechanisms of action, such as prucalopride, plecanatide, elobixibat, and tenapanor, which may show promise in patients with IBS-C and CIC who have not responded to other therapies 6
Treatment Approach
The treatment approach for IBS-M should be individualized and based on the patient's symptoms and severity of disease 5. A step-wise approach can be used, starting with dietary modification and lifestyle changes, and progressing to pharmacological treatments as needed 2, 3. It is essential to consider the patient's prior medical history, mode of action, cost, availability, managed care coverage, and adverse event profiles when selecting a treatment option 5.