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Symptoms of IBS
- abdominal pain or discomfort
- altered bowel habits (diarrhea, constipation, or alternating both)
- physical and emotional distress
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Therapy for the abdominal pain caused by IBS
- myorelaxants (hycosamine and dicyclomine - avail in US but not shown effective)
- opioid receptor agonists (loperamide - inconsistent data)
- peppermint oil (may help, but study design not awesome)
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Treatment of abdominal distention and bloating from gas in IBS
- Beano (alpha-galactosidase) supposed to decr gas, but doesn't help in IBS
- simethicone and activated charcoal don't work either
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Antibiotics that may be beneficial in IBS related bloating
- rifaximin
- metronidazole
- neomycin
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Treatment of C-IBS
- Soluble fiber - can increase stool consistency and decrease colonic transit time (ispaghula, calcium polycarbophil, psyllium) 20-25 g/d recommended
- Stool softeners (docusate sodium)
- Emollients (mineral oil)
- Bowel stimulants (bisacodyl, cascara, senna, ricineoleic acid)
- Osmotic laxatives (glycerin, lactulose, Mg salts, sodium, phosphate, sorbitol)
- PEG (efficacy in one small study)
- Lubiprostone -for women who have failed tx - MOA is CCl2 channel activator in GIT which increases intestinal secretions to facilitate intestinal motility
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Treatment for D-IBS
- loperamide (decreases bowel freq)
- alosetron (available with strict limited license)
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What is the FDA status and role in IBS therapy of lubiprostone, tegaserod, and alosetron?
- lubiprostone: recently approved for women > 18 who have failed other tx
- tegaserod: was for constipation, but no longer on mkt
- alosetron: use limited to D-IBS women who are refractory to other tx - prescribed only with limited license
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Role of non-drug and alternative therapies for IBS
- peppermint oil may help with abdominal pain
- probiotics may decr bloating and gas
- fiber - soluble is good for constipation; insoluble worsens bloating and pain
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