Meta-Analysis: The Treatment of Irritable Bowel Syndrome

D. Lesbros-Pantoflickova; P. Michetti; M. Fried; C. Beglinger; A. L. Blum


Aliment Pharmacol Ther. 2004;20(11) 

In This Article

General Treatment Approach

The IBS is a complex disorder encompassing a wide profile of symptoms. Several pathophysiological mechanisms are involved in producing each symptom. A major problem regarding the treatment of IBS is that there is no well-defined drug target, mainly because of the involvement of multiple receptors or mediators. Additionally, IBS is a clinical condition defined by symptom-based diagnostic criteria and the multitude of symptoms limits the efficacy of many IBS drugs because they target just one or two contributing mechanisms.[11]

The general treatment approach in IBS is to alleviate the symptoms of abdominal pain/discomfort and altered bowel transit (constipation and/or diarrhoea) as well as their consequences such as bloating and anal incontinence.

The approach adopted depends on the intensity of symptoms, the patient's need for health care, and the degree of psychosocial comorbidities ( Table 1 ).[11] Initial treatment is directed towards education, reassurance, dietary/lifestyle modification (if not already attempted independently by the patient), as well as appropriate pharmacotherapy. Patients should be reassured that IBS is a real medical disorder, but typically does not lead to life-threatening disease or physical impairment.[12,13] Short-term medication should be prescribed during exacerbations of IBS symptoms.

A proportion of patients (approximately 10%) frequently experience symptoms and attend secondary care services (Figure 1). Psychological disturbances may or may not be present ( Table 1 ).[11] Traditionally, treatment is mainly based on conventional pharmacotherapy targeted at the specific predominant symptom.

A small proportion of patients (approximately 1%) have severe and refractory symptoms and are referred to tertiary care centres ( Table 1 , Figure 1). In these cases, tailored pharmacotherapy of symptoms and, if required, psychological support is recommended.[14]


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