From the Guidelines
Treatment options for Irritable Bowel Syndrome (IBS) should prioritize a combination approach that includes dietary modifications, medications, and psychological therapies tailored to symptom type and severity, with the most recent evidence suggesting that tricyclic antidepressants like amitriptyline or SSRIs can reduce pain and improve gut motility by affecting the gut-brain axis 1.
Key Considerations
- Dietary changes are often first-line and include following a low-FODMAP diet, which restricts fermentable carbohydrates for 4-6 weeks before systematic reintroduction, as recommended by the British Society of Gastroenterology guidelines 1.
- Increasing soluble fiber (like psyllium at 3-4g daily) can help with constipation, while avoiding gas-producing foods may reduce bloating.
- For medication options, antispasmodics such as dicyclomine or hyoscyamine can relieve abdominal pain, while loperamide helps with diarrhea, and polyethylene glycol or lubiprostone addresses constipation.
- Newer targeted treatments include rifaximin for IBS-D and linaclotide for IBS-C, as suggested by the Rome Foundation working team report on post-infection IBS 1.
Psychological Interventions
- Psychological interventions such as cognitive behavioral therapy, gut-directed hypnotherapy, and stress management techniques have shown effectiveness by addressing the brain-gut connection that influences IBS symptoms 1.
- These interventions can be delivered by a multidisciplinary team, including gastroenterologists, dietitians, and gastropsychologists, and can empower patients to self-manage their condition over time.
Multidisciplinary Management
- An integrated care model that includes medical management, dietary modifications, and psychological therapy is currently considered best practice for management of IBS, especially in patients with mental health comorbidity 1.
- This approach can help address the shared pathophysiology between IBS and mental health disorders, such as anxiety and depression, and can improve global symptoms and quality of life.
From the FDA Drug Label
Lubiprostone is indicated for the treatment of irritable bowel syndrome with constipation (IBS-C) in women at least 18 years old. LINZESS is a guanylate cyclase-C agonist indicated for treatment of: Irritable bowel syndrome with constipation (IBS-C) in adults.
Treatment options for Irritable Bowel Syndrome (IBS) include:
From the Research
Treatment Options for Irritable Bowel Syndrome (IBS)
The treatment of IBS can be challenging due to the heterogeneity of the disorder. The following are some of the treatment options available:
- Lifestyle and dietary changes, including a low-FODMAP or gluten-free diet, are often the first line of treatment for IBS patients 4
- Medications such as laxatives, prokinetics, and antidiarrheals can be used to treat constipation and diarrhea, while antispasmodics can be used to treat abdominal pain 4, 5
- Low doses of neuromodulators, such as tricyclic antidepressants, can help control GI and central symptoms, but may have severe side effects 4, 6
- Probiotics, antibiotics, histamine-receptor antagonists, and alternative therapies like psychotherapy, hypnotherapy, acupuncture, or phytomedicines may also be used to treat refractory IBS symptoms 4, 7
- Brain-gut behavioral therapies, such as cognitive-behavioral therapy, can be effective in patients who are refractory to standard therapies 8
Medications for IBS
Some medications that have been shown to be effective in treating IBS symptoms include:
- Loperamide, fibre supplements, lubiprostone, tricyclic antidepressants, selective serotonin receptor inhibitors, antispasmotics, rifaximin, pregabalin, gabapentin, clonidine, octreotide, and probiotic treatments 5
- 5HT3 receptor antagonists and 5HT(4) receptor agonists can be effective in relieving global IBS symptoms and individual symptoms such as abdominal pain and abnormal bowel habits 7
- Selective C-2 chloride channel activator can be effective in relieving global IBS symptoms in patients with constipation-predominant IBS 7
Dietary Changes
Dietary changes can play an important role in managing IBS symptoms. Some dietary changes that may be helpful include:
- A low-FODMAP diet, which involves limiting or avoiding certain types of carbohydrates that can be difficult for some people to digest 4
- A gluten-free diet, which may be helpful for some people with IBS who also have celiac disease or non-celiac gluten sensitivity 4
- Increasing dietary fiber, which can help regulate bowel movements and improve symptoms of constipation 5, 7