From the Guidelines
Treatment for post-infectious Irritable Bowel Syndrome (IBS) should prioritize a multifaceted approach including dietary modifications, medication, and psychological therapies to manage symptoms and improve quality of life.
Key Recommendations
- Dietary modifications are crucial, with soluble fibre, such as ispaghula, recommended as an effective treatment for global symptoms and abdominal pain in IBS 1.
- A diet low in fermentable oligosaccharides, disaccharides, and monosaccharides and polyols (low-FODMAP diet) may be considered as a second-line dietary therapy under the supervision of a trained dietitian 1.
- Medications such as loperamide for diarrhea-predominant IBS and certain antispasmodics for abdominal pain can be effective, but their use should be tailored to the individual's symptoms and side effect profile 1.
- Psychological therapies, including IBS-specific cognitive behavioural therapy and gut-directed hypnotherapy, may be efficacious for global symptoms in IBS, especially when symptoms persist despite other treatments 1.
Additional Considerations
- Regular exercise is advised for all patients with IBS, although the quality of evidence is weak 1.
- Probiotics may be considered, but due to the low quality of evidence, it's reasonable to advise patients to try them for up to 12 weeks and discontinue if there's no improvement in symptoms 1.
- Stress management techniques, including cognitive behavioral therapy, gut-directed hypnotherapy, and regular exercise, are important for managing symptoms exacerbated by stress through the gut-brain axis. Given the complexity and variability of post-infectious IBS, a personalized approach considering the patient's specific symptoms, medical history, and preferences is essential for effective management.
From the FDA Drug Label
XIFAXAN is indicated for the treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults. The treatment for post-infectious Irritable Bowel Syndrome (IBS) is rifaximin (XIFAXAN), which is indicated for the treatment of IBS-D in adults 2.
- Key points:
- Rifaximin (XIFAXAN) is used to treat IBS-D.
- It is effective in reducing abdominal pain and improving stool consistency.
- The treatment is for adults with IBS-D 2.
From the Research
Treatment Options for Post-Infectious IBS
The treatment for post-infectious Irritable Bowel Syndrome (IBS) typically involves a combination of non-pharmacological and pharmacological interventions. Some key options include:
- Dietary and lifestyle modifications, which are often used as first-line therapy 3, 4
- Probiotics, which have demonstrated efficacy and safety in patients with IBS, although studies are inconsistent in terms of strains, dosing, and treatment duration 3, 4
- Psychological therapies, such as cognitive behavioral therapy and hypnotherapy, which may improve IBS symptoms 3, 4
Pharmacological Interventions
Pharmacological interventions for post-infectious IBS may include:
- Eluxadoline, rifaximin, and alosetron, which are US Food and Drug Administration-approved agents for the management of IBS with diarrhea (IBS-D) 3, 5, 6
- Loperamide, smooth muscle antispasmodics, bile acid sequestrants, and antidepressants, which may also be used to manage IBS-D symptoms 3, 6
- Glutamine supplements, which have been shown to reduce IBS-related endpoints in patients with postinfectious IBS-D and intestinal hyperpermeability 7
Considerations for Treatment
When formulating a management plan for patients with post-infectious IBS, it is essential to consider the most troublesome symptoms, quality of life, symptom intensity, and individual patient preferences 3. The risk-benefit ratio of each medication should also be carefully evaluated, particularly in the treatment of functional GI disorders such as IBS-D 3.