Treatment of irritable bowel syndrome: beyond fiber and antispasmodic agents

Abstract

Irritable bowel syndrome (IBS) is a chronic functional disorder of the gastrointestinal tract of unknown etiology. The diagnosis of IBS is made clinically, using symptom-based criteria such as the Manning or Rome criteria. Medical therapy for this condition has traditionally been directed towards symptom relief, using fiber or antispasmodic agents. In recent years, emerging data have confirmed the efficacy of antidepressants, psychological therapies, 5-HT 3 antagonists, 5-HT 4 agonists, and probiotics in the short-term treatment of IBS, although whether these therapies influence the long-term course of the disease is unknown. Increasing knowledge regarding the pathophysiological mechanisms underlying IBS has resulted in a number of novel molecular treatments, which show promise. These include therapies targeting gastrointestinal mucosal chloride channels and guanylate cyclase-C receptors, as well as highly selective agents influencing serotonergic transmission that, at the time of writing, do not appear to have any severe deleterious effects. In this article we provide a summary of current and emerging therapies in this field.

Cognitive-behavioral therapy for the management of irritable bowel syndrome

“…IBS is a prevalent chronic relapsing condition that is regularly associated with significant disability and has a considerable financial burden for the health service due to the consumption of resources including physician time, investigations, and costs of treatment [66] . The presence of clinically significant psychiatric symptoms in patients with IBS is an indication for psychotherapy, especially CBT.…”

Comparison of electroacupuncture and moxibustion on brain-gut function in patients with diarrhea-predominant irritable bowel syndrome: A randomized controlled trial

“…(27) At present, no drug has been shown to alter the clinical course of IBS, and most of the treatments available currently have only a modest effect on symptom improvement, with their effi cacy in the longer term remaining unknown. (28) By contrast, acupuncture and Mox can effectively treat IBS through regulation of brain, gastrointestinal tract and other channels. (14)(15)(16)(17)(18)(19)(20)29) In this trial, we observed that 5-HT and 5-HT3R expressions in colon tissue of D-IBS patients before treatment were higher than healthy volunteers.…”

Managing Irritable Bowel Syndrome

“…59, 61, 71 Since SSRIs tend to stimulate gut motility, they may be more useful in patients with IBS-C. 66, 68, 71 The adverse effects of SSRIs include diarrhea, nausea, and cramping. 81 Global symptoms of IBS are more likely to improve with the use of antidepressants, although there are limited data on their safety and tolerability within this treatment context.…”