Thematic Review Series on Gastroenterological DiseasesManagement Options for Irritable Bowel Syndrome
Section snippets
Dietary Modifications
Many patients believe that their IBS symptoms are due to food sensitivity.12
Prebiotics and Probiotics
Prebiotics include food ingredients such as fructo-oligosaccharides or inulin that remain undigested in the human gastrointestinal system and can promote the growth or activity of gut bacteria. In contrast, probiotics are live or attenuated microorganisms that can affect the composition of the intestinal microorganisms. Probiotics may have anti-inflammatory and antinociceptive properties.49, 50, 51, 52
Two trials of prebiotics in IBS were reported in the past 3 years. An RCT of 12 weeks'
Medications for Pain
Numerous pharmacological agents for treatment of IBS are currently available, with varying modes of action, efficacy, quality of data, and adverse events (Table).
Medications for Diarrhea
Opioid agents and antidepressants (TCAs and SNRIs) may relieve diarrhea in addition to their effects on pain (Table).
Intestinal Secretagogues
Lubiprostone is a prostaglandin derivative that acts on chloride channels on the apical membrane of the intestinal enterocyte to induce chloride secretion, which is then followed by the passive movement of sodium ions and water into the lumen. As a result, stools become looser and gastrointestinal transit is accelerated.129 The drug is approved at a dose of 8 μg twice daily for women with IBS-C130 and 24 μg twice daily for men and women with chronic constipation.131, 132 There are general
Conclusion
Currently, the treatment of IBS remains focused on treating the patient's most troublesome symptom. These treatments are quite efficacious for bowel dysfunction, although the treatment of pain without use of opioids or centrally acting agents is suboptimal. Hence, lifestyle interventions including diet, cognitive behavioral therapy and hypnotherapy (the lattermost not discussed here) should be considered to relieve symptoms in a holistic approach to the patient's symptoms. Pharmacotherapies
Acknowledgments
The funding organization had no role in the design and execution of the study, in the collection, analyses, and interpretation of the data, or in the preparation, review, or approval of the submitted manuscript.
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Grant Support: This work was supported by grant R01-DK92179 and R01-DK115950 from the National Institutes of Health.
Potential Competing Interests: Dr Camilleri has received research funding regarding this topic from Novartis AG, Allergan, and Entera Health, Inc. He has done consulting regarding this topic (with the fee going to his employer, Mayo Clinic) for Elobix AB, Shire, and Takeda Pharmaceutical Company Limited.
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