From the Guidelines
Irritable Bowel Syndrome (IBS) treatment should commence with dietary therapies or first-line drugs, and all patients should be advised of the potential benefits of regular exercise.
Treatment Recommendations
- Dietary therapies: Soluble fibre, such as ispaghula, is an effective treatment for global symptoms and abdominal pain in IBS, and should be commenced at a low dose (3–4 g/day) and built up gradually to avoid bloating 1.
- Low FODMAP diet: A diet low in fermentable oligosaccharides, disaccharides and monosaccharides and polyols, as a second-line dietary therapy, is an effective treatment for global symptoms and abdominal pain in IBS, but its implementation should be supervised by a trained dietitian 1.
- First-line drugs: Loperamide may be an effective treatment for diarrhoea in IBS, and certain antispasmodics may be an effective treatment for global symptoms and abdominal pain in IBS 1.
- Neuromodulators: Should be used as second-line treatment for IBS, with low-dose tricyclic antidepressants (TCAs) preferred for gastrointestinal symptoms, and selective serotonin reuptake inhibitors preferred if there is a concurrent mood disorder 1.
- Psychological therapies: Gut-directed hypnotherapy, cognitive behavioural therapy, and mindfulness-based stress reduction may be effective treatments for IBS, particularly for patients with co-occurring symptoms of anxiety or depression 1.
Key Considerations
- Patient-centred approach: Treatment should be tailored to the individual, taking into consideration nutrition status, physical and mental comorbidities, and psychosocial factors 1.
- Regular exercise: All patients should be advised of the potential benefits of regular exercise, as there is some evidence that this can be beneficial, particularly for constipation 1.
- Multidisciplinary management: A multidisciplinary approach, involving gastroenterologists, dietitians, and psychologists, may be necessary for patients with complex symptoms or co-occurring mental health conditions 1.
From the Research
Treatment Recommendations for Irritable Bowel Syndrome (IBS)
The treatment of IBS is challenging due to the heterogeneity of the disorder, and finding the correct treatment option is often difficult 2.
- Lifestyle and Dietary Changes: The first-line treatment for all patients with IBS includes lifestyle and dietary changes, such as a low-FODMAP or gluten-free diet 2.
- Medications: When lifestyle changes do not lead to adequate symptom relief, patients should be treated according to their predominant bowel habits and most prominent symptoms. Laxatives or prokinetics and antidiarrheals are used to treat constipation and diarrhea, respectively, but have little effect on abdominal pain 2.
- Antispasmodics and Neuromodulators: Antispasmodics can be used to treat gastrointestinal symptoms, and low doses of neuromodulators can help control gastrointestinal and central symptoms 2.
- Refractory IBS Symptoms: Refractory IBS symptoms can be treated with probiotics, antibiotics, histamine-receptor antagonists, or alternative therapy, including psychotherapy, hypnotherapy, acupuncture, or phytomedicines 2.
Pharmacologic Therapies
Several pharmacologic therapies are available for the treatment of IBS, including:
- Loperamide: Effective in improving symptoms of diarrhea-predominant IBS 3.
- Fibre supplements: Effective in improving symptoms of constipation-predominant IBS 3.
- Lubiprostone: Effective in improving symptoms of constipation-predominant IBS 3.
- Tricyclic antidepressants: Effective in relieving global IBS symptoms and individual symptoms such as abdominal pain 3, 4.
- Selective serotonin receptor inhibitors: Effective in relieving global IBS symptoms and individual symptoms such as abdominal pain 3.
Non-Pharmacologic Therapies
Non-pharmacologic therapies, including:
- Psychotherapy: Effective in improving global symptoms in some IBS patients 4.
- Dietary intervention: Avoiding dietary triggers can be efficacious for the management of IBS symptoms 5.
- Brain-gut behavioral therapies: Increasingly used to treat symptoms of IBS, particularly in those who do not respond to traditional therapies 5.
- Virtual reality: Represents an exciting new approach to treating DGBIs, like IBS, though data are limited 5.