From the Guidelines
Treatment for Irritable Bowel Syndrome (IBS) should start with dietary changes and lifestyle modifications, including a low-FODMAP diet and regular exercise, as these approaches have been shown to improve symptoms and quality of life 1. When managing IBS, it's essential to identify the specific subtype (constipation-predominant, diarrhea-predominant, or mixed) to guide treatment.
- Dietary management should include a low-FODMAP diet for 4-6 weeks, followed by gradual reintroduction of foods to identify triggers.
- Common medications for IBS include:
- Antispasmodics like dicyclomine (10-20mg three times daily) for abdominal pain.
- Loperamide (2-4mg as needed) for diarrhea.
- Fiber supplements like psyllium (1 tablespoon daily) for constipation.
- For severe cases, prescription medications such as linaclotide (145-290mcg daily) for constipation or rifaximin (550mg three times daily for 14 days) for diarrhea may be prescribed.
- Stress management through regular exercise, adequate sleep, and relaxation techniques like meditation can significantly reduce symptom frequency and severity. According to the British Society of Gastroenterology guidelines, soluble fibre, such as ispaghula, is an effective treatment for global symptoms and abdominal pain in IBS, but insoluble fibre should be avoided as it may exacerbate symptoms 1. Additionally, a meta-analysis of studies demonstrated a significant benefit of tricyclic antidepressants (TCAs) for abdominal pain compared with placebo, making TCAs a suitable option for abdominal pain management in IBS 1. Regular follow-up with a healthcare provider is crucial to adjust treatment as needed and ensure the best possible outcomes for patients with IBS.
From the FDA Drug Label
1 INDICATIONS AND USAGE VIBERZI is indicated in adults for the treatment of irritable bowel syndrome with diarrhea (IBS-D).
- 3 Irritable Bowel Syndrome with Constipation Lubiprostone is indicated for the treatment of irritable bowel syndrome with constipation (IBS-C) in women at least 18 years old.
Irritable Bowel Syndrome (IBS) Treatment:
- Eluxadoline (PO) is indicated for the treatment of IBS-D in adults 2.
- Lubiprostone (PO) is indicated for the treatment of IBS-C in women at least 18 years old 3. Key points:
- Eluxadoline is used for IBS-D.
- Lubiprostone is used for IBS-C in women.
From the Research
Treatment Options for IBS
- Nonpharmacological interventions, such as dietary and lifestyle modification, are generally used as first-line therapy for IBS treatment 4
- Probiotics have demonstrated efficacy and safety in patients with IBS, but studies are inconsistent in strains examined, dosing, and treatment duration 4
- Psychological therapies, including cognitive behavioral therapy and hypnotherapy, may also improve IBS symptoms 4
Pharmacological Interventions
- US Food and Drug Administration-approved agents for IBS-D include eluxadoline, rifaximin, and alosetron 4
- Other pharmacological interventions for IBS-D include loperamide, smooth muscle antispasmodics, bile acid sequestrants, and antidepressants 4, 5, 6
- Rifaximin has been shown to improve abdominal pain and stool consistency in patients with IBS-D, and has a favorable safety profile 4, 5, 6
Personalized Approach to Treatment
- A personalized approach to IBS treatment is required, taking into account the individual patient's symptoms, quality of life, and preferences 5, 7
- A multidisciplinary approach, including medicinal care, complementary therapies, and lifestyle modifications, may be beneficial in improving symptoms and quality of life 8
Emerging Therapies
- Emerging therapies, such as fecal microbiota transplantation and the use of probiotics, prebiotics, and synbiotics, may offer potential benefits in IBS treatment 5
- Novel drugs are currently in development, targeting the pathophysiology of IBS, including intestinal secretagogues, drugs acting on opioid or 5-HT receptors, and minimally absorbed antibiotics 7