From the Guidelines
Treatment for irritable bowel syndrome (IBS) in adolescents should prioritize a multidisciplinary approach, incorporating lifestyle and dietary modifications, as well as psychological therapies, to address the complex interplay between gastrointestinal symptoms and mental health comorbidities, as recommended by recent guidelines 1. The treatment of IBS in adolescents is generally directed towards the predominant symptom, or symptoms, experienced by the patient. All patients should be advised of the potential benefits of regular exercise, as there is some evidence from RCTs that this can be beneficial, particularly for constipation, with beneficial effects still apparent at 5 years in one trial 1. Key components of treatment include:
- Identifying and avoiding trigger foods, particularly those high in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols)
- Regular exercise
- Stress management techniques like mindfulness or yoga
- Adequate sleep For medication, options such as loperamide (Imodium) for diarrhea and antispasmodics like dicyclomine for abdominal pain may be considered. Psychological approaches, including cognitive behavioral therapy (CBT) and gut-directed hypnotherapy, have shown effectiveness for IBS symptoms in adolescents and should be considered, especially when symptoms have not improved after 12 months of drug treatment 1. It is essential to adopt an evidence-based approach to IBS treatment and communicate this accurately to patients to avoid dissatisfaction with outcomes and mistrust of the diagnosis, which can lead to seeking alternative therapies with lacking robust evidence 1. In cases of more severe symptoms, low-dose tricyclic antidepressants such as amitriptyline might be considered under medical supervision, given their potential benefits in reducing abdominal pain and improving symptoms 1. Probiotics, particularly those containing Bifidobacterium or Lactobacillus strains, may also provide some benefit in managing IBS symptoms. Ultimately, the goal of treatment is to address the brain-gut connection, normalize gut motility, and reduce visceral hypersensitivity that contributes to pain and altered bowel habits, thereby improving the quality of life for adolescents with IBS.
From the FDA Drug Label
1 INDICATIONS AND USAGE
To reduce the development of drug-resistant bacteria and maintain the effectiveness of XIFAXAN and other antibacterial drugs, XIFAXAN when used to treat infection should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria
- 3 Irritable Bowel Syndrome with Diarrhea XIFAXAN is indicated for the treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults.
The treatment option for Irritable Bowel Syndrome (IBS) in adults is Rifaximin (XIFAXAN), specifically for IBS-D (Irritable Bowel Syndrome with Diarrhea).
- Key points:
- Rifaximin is indicated for the treatment of IBS-D in adults.
- The FDA label does not specifically address the treatment of IBS in adolescents. 2
From the Research
Treatment Options for Irritable Bowel Syndrome (IBS) in Adolescents
- Nonpharmacological interventions:
- Dietary and lifestyle modification, which are generally used as first-line therapy 3
- Probiotics have demonstrated efficacy and safety in patients with IBS, but studies are inconsistent in strains examined, dosing, and treatment duration 3
- Psychological therapies (e.g. cognitive behavioral therapy, hypnotherapy) also may improve IBS symptoms 3
- Dietary modification is often the first line of therapy 4
- Lifestyle treatments include complementary alternative medications (CAM), probiotics and peppermint oil are useful adjuncts 4
- Evidence strongly supports psychotherapy in the treatment of IBS 4
- Pharmacological interventions:
- The US Food and Drug Administration-approved agents eluxadoline, rifaximin, and alosetron 3, 5, 6
- Loperamide, smooth muscle antispasmodics, bile acid sequestrants, and antidepressants (i.e. tricyclic antidepressants, selective serotonin reuptake inhibitors) 3
- Eluxadoline and rifaximin have been shown to improve abdominal pain and stool consistency in patients with IBS-D 3
- Alosetron improves IBS symptoms; however, it is approved only for women with severe IBS-D 3
- Rifaximin has the most favorable safety profile 3
- Antispasmodics are used for targeting abdominal pain and loperamide for diarrhea only 7
- Additional therapeutic options for the relief of global IBS symptoms include rifaximin, 5-HT 3 antagonists, gut-directed psychological therapies, and eluxadoline 7
- Tricyclic antidepressants can target abdominal pain and bile acid sequestrants diarrhea 7