Updates on treatment of irritable bowel syndrome

Abstract

Irritable bowel syndrome (IBS) is a highly prevalent gastrointestinal disorder characterized by abdominal pain and discomfort in association with altered bowel habits. It is estimated to affect 10%-15% of the Western population, and has a large impact on quality of life and (in)direct healthcare costs. IBS is a multifactorial disorder involving dysregulation within the brain-gut axis, and it is frequently associated with gastrointestinal motor and sensory dysfunction, enteric and central nervous system irregularities, neuroimmune dysregulation, and postinfectious inflammation. As with other functional medical disorders, the treatment for IBS can be challenging. Conventional therapy for those with moderate to severe symptoms is largely unsatisfactory, and the development of new and effective drugs is made difficult by the complex pathogenesis, variety of symptoms, and lack of objective clinical findings that are the hallmark of this disorder. Fortunately, research advances over the past several decades have provided insight into potential mechanisms responsible for the pathogenesis of IBS, and have led to the development of several promising pharmaceutical agents. In recent years there has been much publicity over several of these new IBS medications (alosetron and tegaserod) because of their reported association with ischemic colitis and cardiovascular disease. While these agents remain available for use under restricted prescribing programs, this highlights the need for continued development of safe and effective medication for IBS. This article provides a physiologicallybased overview of recently developed and frequently employed pharmaceutical agents used to treat IBS, and discusses some non-pharmaceutical options that may be beneficial in this disorder.

Self-Reported Use of Pharmaceuticals Among Patients With Irritable Bowel Syndrome in Primary Care

“…9 Pharmacological interventions have supposedly been directed at the predominant symptoms, yet, to date, no single drug has been shown to have an effect on all of the multiple symptoms of IBS. 11,13 Correspondingly, reports confirm that prescriptions for patients with IBS are dominated by 4 drug classes (in addition to laxatives): gastrointestinal motility agents, antispasmodics, absorbents, and antiflatulents. From a patient view, it is important that symptoms experienced are taken seriously so that treatment can be initiated early to avoid unnecessary suffering.…”

“…This trend in the use of antidepressants is in accordance with findings from other studies. 11,21 The increased use of antidepressants may reflect a growing interest to use this category of drugs for modulation of gut sensory-motor function and pain in IBS. 21 An alternative explanation is that there is an increased awareness among primary care physicians of the comorbidity of IBS and psychiatric disease.…”

“…The treatment approach should also be individualized and depend on the degree of symptoms from the different sub-classes of IBS. 11,16 This trend is also seen in self-medication with over-the-counter (OTC) drugs, although the majority of patients with IBS receive prescription medications. 3,[17][18] While many drugs have been used in the treatment of IBS in the United States, only 2 drugs have been approved by the U.S. Food and Drug Administration specifically for this indication.…”

“…The interventions range from pharmaceutical treatment (e.g., antispasmodic and motility-regulating agents used alone or in combination with laxatives, antidiarrheal fiber therapy, or tricyclic antidepressants) to nondrug therapies (e.g., hypnotherapy, cognitive behavioral therapy). 11 Use of psychotherapy, particularly cognitive behavioral therapy is the best studied psychological treatment of IBS, but there are no head-to-head trials of psychotherapy versus pharmacotherapy. [12][13][14][15] Patients' self-assessments of their symptoms have therefore been recognized as important for the effective treatment of IBS.…”

State-of-the-art of irritable bowel syndrome and inflammatory bowel disease research in 2008

“…Hammerle and Surawicz review the challenges of treating patients with IBS [12] . The effectiveness of conventional therapy for IBS varies due to the need to treat different types of symptoms (IBS-D, IBS-C or IBS-A) and the need to limit underlying etiologic triggers, which are commonly unknown.…”