From the Guidelines
Treatment of IBS mixed subtype (IBS-M) should prioritize a personalized approach, focusing on lifestyle modifications, dietary changes, and medication management, with the goal of reducing morbidity, mortality, and improving quality of life, as recommended by the most recent guidelines 1.
Key Considerations
- Lifestyle modifications, such as regular exercise and stress management techniques, are essential for managing IBS-M symptoms 1.
- Dietary changes, including a low-FODMAP diet, can help identify trigger foods and alleviate symptoms 1.
- Soluble fiber supplements, like psyllium (Metamucil), can regulate bowel movements and improve symptoms 1.
Medication Management
- Peppermint oil capsules may reduce abdominal pain and bloating, while loperamide and osmotic laxatives can be used to manage diarrhea and constipation, respectively 1.
- For patients with severe symptoms, prescription medications like eluxadoline, linaclotide, or lubiprostone can address diarrhea, constipation, and pain 1.
- Tricyclic antidepressants, such as amitriptyline, or SSRIs, like citalopram, can be effective for pain and global symptoms, targeting the gut-brain axis and visceral hypersensitivity 1.
Treatment Approach
- A multidisciplinary approach, incorporating medical, dietary, and psychological therapies, is crucial for effective management of IBS-M, considering the complex interplay between gastrointestinal symptoms and psychological comorbidity 1.
- Regular follow-up and monitoring of symptom changes are essential to adjust treatment as needed and ensure optimal outcomes 1.
From the FDA Drug Label
Dicyclomine hydrochloride tablets, USP are indicated for the treatment of patients with functional bowel/irritable bowel syndrome. In controlled clinical trials involving over 100 patients who received drug, 82% of patients treated for functional bowel/irritable bowel syndrome with dicyclomine hydrochloride at initial doses of 160 mg daily (40 mg four times daily) demonstrated a favorable clinical response compared with 55% treated with placebo (p<0.05).
Treatment of IBS mixed subtype can be done with dicyclomine (PO), as it is indicated for the treatment of patients with functional bowel/irritable bowel syndrome 2. The drug has shown a favorable clinical response in 82% of patients treated at initial doses of 160 mg daily (40 mg four times daily) compared to placebo 2.
- Key points:
- Indicated for functional bowel/irritable bowel syndrome
- Favorable clinical response in 82% of patients
- Initial dose: 160 mg daily (40 mg four times daily)
From the Research
Treatment Options for IBS Mixed Subtype
- The treatment of IBS mixed subtype (IBS-M) often involves a multidisciplinary approach, including primary care, gastroenterologist, and psychologist 3.
- Dietary modification is often the first line of therapy, and lifestyle treatments such as complementary alternative medications (CAM), probiotics, and peppermint oil can be useful adjuncts 3.
- Pharmacological treatment options for IBS-M include anti-diarrheals, anti-spasmodics, and anti-depressants, as well as medications that target bile acid malabsorption, such as rifaximin, eluxadoline, and alosetron 3.
Non-Pharmacological Therapies
- Lifestyle and dietary changes, including the low-FODMAP or gluten-free diet, are often recommended as first-line treatment for IBS-M 4.
- Psychotherapy, hypnotherapy, acupuncture, and phytomedicines may also be effective in improving global symptoms in some IBS-M patients, although the evidence is limited 4, 5.
- A multidisciplinary approach, including medicinal care, Chinese medicine, reflexology, and naturopathy, has been shown to be effective in improving symptoms and quality of life in some IBS-M patients 6.
Pharmacological Therapies
- Medications such as loperamide, fibre supplements, lubiprostone, tricyclic antidepressants (TCAs), selective serotonin receptor inhibitors (SSRIs), antispasmotics, rifaximin, pregabalin, gabapentin, clonidine, octreotide, and probiotics have been shown to improve various IBS symptoms, including abdominal pain, bloating, and stool form 7.
- The efficacy of these medications can vary depending on the specific IBS subtype and symptoms, and more well-designed studies are needed to better inform therapeutic decision-making in the management of IBS-M 7.