Review Article: Current and future treatment approaches for IBS with diarrhoea (IBS‐D) and IBS mixed pattern (IBS‐M)

Abstract

SummaryBackgroundIrritable bowel syndrome‐diarrhoea (IBS‐D) and IBS‐mixed stool pattern (IBS‐M) are disorders of gut‐brain interaction characterised by abdominal pain associated with diarrhoea or both diarrhoea and constipation respectively. The pathophysiology of IBS‐D/M is multifactorial and not completely understood; thus, treatment is aimed at multiple mechanisms such as altering gut microbiota, visceral hypersensitivity, intestinal permeability, gut‐brain interaction and psychological strategies.AimThe goal of this article was to provide an up‐to‐date review of the current evidence for both non‐pharmacological and pharmacological treatment options in IBS‐D and IBS‐M. Future treatments for IBS‐D and IBS‐M will also be discussed.MethodsMedline and Embase database searches (through April 30 2021) to identify clinical studies in subjects with IBS‐D in which dietary modification, alternative treatments (probiotics, acupuncture, exercise) as well as FDA‐approved medications were used.ResultsDietary modification is often the first line of therapy. Furthermore, lifestyle treatments include complementary alternative medications (CAM), probiotics and peppermint oil are useful adjuncts but have not specifically been described in IBS‐D/M. Evidence strongly supports psychotherapy in the treatment of IBS. Beyond over‐the counter anti‐diarrhoeals, anti‐spasmodics and anti‐depressants, pharmacological treatment now includes treating for bile acid malabsorption and the FDA‐approved medications rifaximin, eluxadoline and alosetron.ConclusionsThe treatment of IBS‐D/M ideally involves a multidisciplinary approach of primary care, gastroenterologist and psychologist. Treatment often involves both non‐pharmacological and pharmacological therapies. Future therapies may include faecal microbial transplant, Crofelemer and serotonin antagonists, but further studies are needed.

Modulation of colonic function in irritable bowel syndrome rats by electroacupuncture at ST25 and the neurobiological links between ST25 and the colon

“…Its complex pathogenesis remains unclear, but some studies have confirmed that IBS is closely related to visceral allergy and altered intestinal motility (Ford et al, 2020). The efficacy of acupuncture in treating IBS is confirmed by its ability to improve visceral hypersensitivity (Liu et al, 2015;Zhao et al, 2017) and adjust colonic motility (Manheimer et al, 2012;Yan et al, 2019;Pei et al, 2020;Nee and Lembo, 2021). ST25 is the main acupoint used in acupuncture to treat IBS , but ST25 has mostly been studied in conjunction with other acupoints, with the use of ST25 alone being rare (Ma et al, 2009;Zhu et al, 2017;Chen et al, 2019).…”

Síndrome de intestino irritable (SII): Nuevos conceptos en 2023.

“…Además de su demostrado efecto en la mejoría de la diarrea y de los síntomas globales, también puede mejorar el dolor en pacientes con SII-Diarrea (139).…”

“…Trimebutina, mebeverina y rociverina, Hioscina hiosciamina y diciclomine, Son similares a placebo (139,140).…”

Fecal microbiota transplantation in patients with post-infectious irritable bowel syndrome: A randomized, clinical trial

“…There are no specific treatment recommendations for PI-IBS; therefore, symptomatic treatment is usually carried out depending on the IBS subtype ( 12 ). Non-pharmacological methods include limiting or excluding foods rich in FODMAPs, which is especially useful in frequent diarrhea, common with PI-IBS ( 13 , 14 ).…”