From the Guidelines
The first line treatment for Irritable Bowel Syndrome (IBS) should focus on lifestyle and dietary modifications, including regular exercise and first-line dietary advice, as these approaches have been shown to be effective in managing global symptoms and abdominal pain in IBS. According to the British Society of Gastroenterology guidelines on the management of IBS 1, all patients with IBS should be advised to take regular exercise and offered first-line dietary advice.
Some key dietary recommendations include:
- Consuming soluble fibre, such as ispaghula, which is an effective treatment for global symptoms and abdominal pain in IBS, but starting at a low dose (3–4 g/day) and building up gradually to avoid bloating 1
- Avoiding insoluble fibre, such as wheat bran, as it may exacerbate symptoms 1
- Considering a diet low in fermentable oligosaccharides, disaccharides, and monosaccharides and polyols as a second-line dietary therapy, under the supervision of a trained dietitian 1
- Not recommending a gluten-free diet or food elimination diets based on IgG antibodies 1
Additionally, lifestyle modifications, such as regular physical activity, stress management, and adequate sleep, are crucial in managing IBS symptoms. While pharmacological treatments, such as loperamide for diarrhea-predominant IBS or certain antispasmodics for global symptoms and abdominal pain, may be considered, they should be used judiciously due to potential side effects and limited evidence 1.
It is essential to note that the quality of evidence for many of these recommendations is weak or very low, emphasizing the need for personalized approaches and ongoing monitoring of symptoms and treatment responses in clinical practice 1.
From the FDA Drug Label
The efficacy of XIFAXAN for the treatment of IBS-D was established in 3 randomized, multi‑center, double-blind, placebo-controlled trials in adult patients. XIFAXAN is recommended for use in patients with IBS-D
The first line treatment for Irritable Bowel Syndrome (IBS), specifically IBS-D (Diarrhea), is XIFAXAN (rifaximin) 550 mg three times a day for 14 days. 2
- Key points:
- XIFAXAN is recommended for use in patients with IBS-D.
- The treatment course is 14 days.
- The dosage is 550 mg three times a day.
From the Research
First Line Treatment for IBS
The first line treatment for Irritable Bowel Syndrome (IBS) typically involves nonpharmacological interventions, including:
- Dietary and lifestyle modification, which are generally used as first-line therapy 3
- Increasing soluble fiber intake, reducing caffeine and alcohol intake, and adequate hydration may lead to symptom improvement 4
Pharmacological Interventions
If nonpharmacological interventions are not effective, pharmacological interventions may be considered, including:
- Over-the-counter medications such as loperamide, which may improve stool frequency and rectal urgency 4
- Prescription medications such as rifaximin, eluxadoline, and alosetron, which have been approved by the FDA for the treatment of IBS-D 3, 5, 4
- Other medications such as tricyclic antidepressants, bile acid sequestrants, and antispasmodics, which may be useful in IBS-D management 4
Individualized Treatment Approach
Treatment of IBS should be individualized and focused on the predominant symptom, which can include:
- Abdominal pain
- Bloating
- Constipation
- Diarrhea
- A combination of dietary interventions and medications may be used to address these symptoms 6