From the Guidelines
Treatment for Irritable Bowel Syndrome (IBS) should prioritize a combination of dietary changes, medications, and lifestyle modifications, with a strong emphasis on soluble fiber supplementation, such as ispaghula, and regular exercise, as recommended by the British Society of Gastroenterology guidelines 1.
Key Recommendations
- Dietary adjustments: Identify trigger foods through an elimination diet, focusing on FODMAPs, and increase fiber intake gradually to 20-30g daily using supplements like psyllium or methylcellulose.
- Medications: Antispasmodics, such as dicyclomine or hyoscyamine, can help with cramping, while loperamide can be effective for diarrhea-predominant IBS, and osmotic laxatives like polyethylene glycol can help with constipation-predominant IBS.
- Lifestyle modifications: Stress management through regular exercise, adequate sleep, and relaxation techniques is crucial, as gut-brain interactions significantly influence IBS symptoms.
- Probiotics: Containing Bifidobacterium or Lactobacillus strains may help some patients.
Considerations for Mental Health Comorbidity
- Integrated care approach: Addressing gastrointestinal symptoms with nutrition and brain–gut behavior therapies is considered the gold standard for managing IBS with comorbid psychological conditions 1.
- Tailoring clinical assessment and treatment: Recommendations include dietary and behavioral interventions that could be applied by non-specialists and clinicians working outside an integrated care model.
Important Considerations
- Quality of evidence: The quality of evidence for some recommendations is weak or very low, highlighting the need for further research and individualized treatment plans.
- Patient empowerment: Empowering patients to self-manage their condition over time is crucial, as IBS is a chronic condition requiring ongoing management.
From the FDA Drug Label
LINZESS is a guanylate cyclase-C agonist indicated for treatment of: Irritable bowel syndrome with constipation (IBS-C) in adults. Lubiprostone is indicated for the treatment of irritable bowel syndrome with constipation (IBS-C) in women at least 18 years old.
IBS Treatment Options:
- Linaclotide (PO) is indicated for the treatment of Irritable Bowel Syndrome with Constipation (IBS-C) in adults 2.
- Lubiprostone (PO) is indicated for the treatment of Irritable Bowel Syndrome with Constipation (IBS-C) in women at least 18 years old 3.
From the Research
IBS Treatment Options
- Medications:
- Loperamide for diarrhea 4
- Ispaghula for constipation 4
- Musculotropic spasmolytics for abdominal pain 4
- Antidepressants for abdominal pain, but with potential tolerance issues 4
- Lubiprostone and linaclotide for IBS with constipation 4, 5
- Ramosetron for IBS with diarrhea (currently only approved in Japan) 4
- Ondansetron for stool pattern in IBS-D 4
- Rifaximin and eluxadoline for IBS-D, with eluxadoline associated with increased risk of sphincter of Oddi spasm and biliary pancreatitis 4
- Non-pharmacological treatments:
- Emerging therapies:
Treatment Approach
- Traditional treatments, such as antispasmodics, antidepressants, and dietary alteration, remain important in the treatment of IBS 8, 7
- Newer agents, such as linaclotide, lubiprostone, and eluxadoline, may be considered for patients who do not respond to traditional treatments 8
- A positive diagnosis of IBS, alongside testing to exclude celiac disease, is recommended 7
- Patients should be offered traditional dietary advice, with specialist dietetic guidance considered if response is incomplete 7