From the Guidelines
Treatment for Irritable Bowel Syndrome (IBS) should prioritize a multidisciplinary approach, incorporating dietary modifications, psychological therapies, and medical management, as this has been shown to improve global symptoms and empower patients to self-manage their condition over time 1.
Key Considerations
- The treatment of IBS is generally directed towards the predominant symptom, or symptoms, experienced by the patient, and 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 1.
- Dietary therapies, such as a low-FODMAP diet, should be considered as a primary treatment for IBS symptoms, as mounting evidence supports their effectiveness in managing IBS symptoms 1.
- Medications, including antispasmodics, laxatives, and gut-brain neuromodulators, can be used to manage specific symptoms, such as abdominal cramping, constipation, or diarrhea.
- Psychological therapies, such as cognitive-behavioral therapy (CBT) and gut-directed hypnotherapy, can help address the mental health comorbidities commonly associated with IBS, such as anxiety and depression 1.
Treatment Options
- For constipation-predominant IBS, fiber supplements like psyllium or medications like linaclotide may help.
- For diarrhea-predominant IBS, loperamide or bile acid sequestrants can be used to manage symptoms.
- Low-dose antidepressants, such as amitriptyline, can help with pain and bowel symptoms by affecting gut nerve signals.
- Probiotics containing Bifidobacterium or Lactobacillus strains may help restore gut bacterial balance.
- Peppermint oil capsules can reduce intestinal spasms.
Lifestyle Modifications
- Regular exercise, adequate sleep, and relaxation techniques like meditation are crucial in managing IBS symptoms, as stress often triggers or worsens symptoms.
- Identifying and avoiding trigger foods through an elimination diet can help manage symptoms.
- A multidisciplinary team approach, including medical management, dietary modifications, and psychological therapy, is considered best practice for managing IBS 1.
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. The efficacy of LINZESS for the treatment of IBS-C was established in two double-blind, placebo-controlled, randomized, multicenter trials in adult patients
Treatment for IBS: Linaclotide (PO) is indicated for the treatment of irritable bowel syndrome with constipation (IBS-C) in adults 2, 2.
- Key points:
- Linaclotide is a guanylate cyclase-C agonist
- Efficacy was established in two double-blind, placebo-controlled trials
- Indicated for treatment of IBS-C in adults
From the Research
Treatment Options for IBS
- Current therapies for IBS are directed at relieving symptoms of abdominal pain or discomfort, bloating, constipation, and diarrhea 3.
- Pharmacologic agents used to treat IBS-associated pain include myorelaxants, peppermint oil, and peripherally acting opiates, although their efficacy is debated 3.
- For constipation-predominant (C-IBS) symptoms, treatment options include fiber supplementation, polyethylene glycol, and tegaserod, with tegaserod demonstrating superiority over placebo in improving bowel frequency and stool consistency 3.
- For diarrhea-predominant (D-IBS) symptoms, available therapies include loperamide, alosetron, and clonidine, with alosetron being superior to placebo for reducing bowel frequency and improving stool consistency 3.
Multidisciplinary Approach to IBS Treatment
- A multidisciplinary approach, including medicinal care, Chinese medicine, reflexology, and naturopathy, has been shown to result in significant improvement in symptoms and quality of life for IBS patients 4.
- This approach emphasizes the importance of integrative treatment in IBS and its benefit in improving patients' quality of life 4.
Emerging Therapies for IBS
- Emerging therapies for IBS-D include rifaximin and eluxadoline, which have significantly added to the pharmacotherapeutic options for patients suffering from IBS-D 5.
- The use of a low FODMAP diet, chloride channel activators, and guanylate cyclase activators has been recommended for the treatment of IBS with constipation symptoms 6.
- Rifaximin has been recommended for the treatment of global IBS with diarrhea symptoms 6.
Gut-Brain Interaction and IBS Treatment
- Altering the gut microbiome via probiotic and antibiotic administration, avoiding dietary triggers, and modulating the gut-brain axis have all proven efficacious for the management of IBS symptoms 7.
- Brain-gut behavioral therapies (BGBTs) are increasingly used to treat symptoms of IBS, particularly in those who do not respond to traditional therapies 7.
- Virtual reality represents an exciting new approach to treating DGBIs, like IBS, although data are limited 7.