Irritable Bowel Syndrome Remains a Difficult Condition to Manage

Nicholas J. Talley, MD, PhD

In This Article


Few agents have been approved for the management of IBS, although many agents are used to try to treat individual symptoms of the con dition. There is good evidence that tegaserod in constipation-predominant IBS and alosetron in diarrhea-predominant IBS are efficacious. However, these drugs are limited by their usefulness in only subgroups of IBS patients. The value of antispasmodic agents is probably limited, albeit based on insufficient data.

Bulking agents may be more efficacious than placebo in terms of global IBS symptom improvement, but this is still controversial; constipation is helped. Loperamide is efficacious for management of diarrhea-predominant symptoms but probably not for other global IBS symptoms. The efficacy of laxatives in IBS has not been tested in clinical trials, but anecdotally, laxatives seem to have limited benefit. Tricyclic antidepressants appear to be effective, but the literature is not clear on this point. Other antidepressant classes remain of uncertain value.

A number of newer agents are currently in testing, but how many of these will reach the marketplace remains unclear.[58] In the meantime, reassurance and advice, dietary therapy, and patient support remain the basis of management of this chronic condition.


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