From the Guidelines
Treatment for Irritable Bowel Syndrome (IBS) should start with identifying the specific IBS subtype and then implementing a combination of dietary changes, medications, and lifestyle modifications, with a strong emphasis on regular exercise and stress management techniques, as recommended by the British Society of Gastroenterology guidelines 1. The treatment approach should be tailored to the individual's symptoms, with dietary management options including the low-FODMAP diet, which has been shown to be effective in reducing global symptoms and abdominal pain in IBS patients 1. For IBS with constipation, medications like fiber supplements, osmotic laxatives, or prescription medications such as linaclotide or lubiprostone can be effective, while for IBS with diarrhea, loperamide, bile acid sequestrants, or eluxadoline may provide relief 1. Antispasmodics like dicyclomine can reduce abdominal pain, and tricyclic antidepressants like amitriptyline or SSRIs may help with pain and gut-brain interaction, with TCAs being the first choice for abdominal pain due to their significant benefit compared to placebo 1. Regular exercise, stress management techniques like meditation, adequate sleep, and staying hydrated are essential complementary approaches that help regulate gut function and reduce symptom severity, and should be prioritized in the treatment plan 1. It is also important to consider the potential impact of mental health comorbidity on IBS treatment, and to adopt an evidence-based approach to treatment, communicating this accurately to patients to avoid dissatisfaction and mistrust of the diagnosis 1.
From the Research
Treatment Options for IBS
- Pharmacological treatments for IBS include fibre, antidiarrhoeals, and antispasmodics, which play a role in symptomatic treatment 2
- Tricyclic antidepressants (TCAs) have been found to target the enteric neurons and play a role in pain modulation, and are recommended for severe cases of IBS pain 2
- Serotonin (5-hydroxytryptamine; 5-HT) antagonists, specifically 5-HT3 receptor antagonists, have been shown to decrease symptoms in female patients with IBS 2
- 5-HT4 receptor agonists are being developed for the treatment of constipation-predominant IBS 2
Symptom-Based Therapies
- Combinations of drugs to target bothersome symptoms are suggested as the first-line pharmacologic treatment 3
- Symptom-based therapies with dietary fiber, bulking agents, laxatives, antispasmodics, and laxatives are effective in improving some individual symptoms 3
- 5HT3 receptor antagonists and 5HT(4) receptor agonists are effective in relieving global IBS symptoms and individual symptoms such as abdominal pain and abnormal bowel habits 3
Medication Management
- There is evidence to support improvements in specific IBS symptoms following treatment with loperamide, psyllium, bran, lubiprostone, linaclotide, amitriptyline, and other medications 4
- Rifaximin, lubiprostone, linaclotide, fiber supplementation, and peppermint oil have the most reliable evidence supporting their use for the treatment of IBS 4
Non-Pharmacological Strategies
- Non-pharmacological interventions, such as lifestyle modifications and dietary advice, can play an important role in symptom control 5
- Microbiota manipulation through probiotics, prebiotics, and symbiotics is a widely used strategy, although the evidence is still unclear 5
- Psychological therapies may be effective in patients with IBS, despite their limited application due to long duration, high costs, and poor patient acceptance 5