What are the supportive care medications for Gastrointestinal (GI) illness?

From the Guidelines

Supportive care medications for Gastrointestinal (GI) illness include neuromodulators, antidiarrheals, and secretagogues.

Medications for IBS

• Neuromodulators:
  • Tricyclic antidepressants (e.g., amitriptyline 10-50 mg once a day) are effective for global symptoms and abdominal pain in IBS 1
  • Selective serotonin reuptake inhibitors may be effective for global symptoms in IBS, but the evidence is low 1
• Antidiarrheals:
  • Eluxadoline (75-100 mg twice a day) is effective for IBS with diarrhea, but has limitations due to contraindications and availability 1
  • 5-Hydroxytryptamine 3 receptor antagonists (e.g., alosetron, ramosetron, and ondansetron) are effective for IBS with diarrhea, but have varying availability and side effects 1
  • Rifaximin (550 mg three times a day for 14 days) is effective for IBS with diarrhea, but has modest efficacy and concerns about adverse events 1
• Secretagogues:
  • Linaclotide is effective for IBS with constipation, with a high quality of evidence 1
  • Lubiprostone is effective for IBS with constipation, with a moderate quality of evidence 1
  • Plecanatide is effective for IBS with constipation, but has a very low quality of evidence 1

Additional Considerations

• Dietary counseling should be patient-centered and tailored to the individual, taking into consideration nutrition status, physical and mental comorbidities, and psychosocial factors 1
• Low FODMAP diet may be considered for individuals with moderate to severe gastrointestinal symptoms, but should be delivered by a dietitian 1
• Brain-gut behavior therapies (e.g., cognitive behavioral therapy, gut-directed hypnotherapy, and mindfulness-based stress reduction) may be beneficial for patients with IBS and mental health comorbidities 1

From the Research

Supportive Care Medications for Gastrointestinal (GI) Illness

The following are some supportive care medications and interventions for managing GI symptoms:

• Pelvic floor muscle exercise may help to resolve GI symptoms more quickly in the post-operative recovery phase 2
• Rehabilitation programs can improve self-management strategies, especially when administered soon after completing primary treatment 2
• Certain forms of chemotherapy plus supportive care can improve both survival and quality of life in patients with gastrointestinal cancer (gastric and colorectal cancers) compared to receiving supportive care alone 3
• Enteral nutrition (EN) can provide the benefits of maintaining gut functionality, integrity, and immunity as well as decreasing infectious complications in critically ill patients 4

Types of Interventions

Some types of interventions for managing or improving GI symptoms include:

• Rehabilitation programs 2
• Exercise programs, such as pelvic floor muscle exercise 2
• Educational programs 2
• Dietary interventions 2
• Pharmacological interventions 2
• Supportive care, including social, psychological, and spiritual support 3

Medication Therapy

Medication therapy during enteral feeding in critically ill adult patients can impact GI motility and EN delivery 4. Commonly used medications in the intensive care unit can have an impact on GI motility and EN delivery, and their role should be carefully considered 4.