New Therapies in Irritable Bowel Syndrome: What Works and When

Orla Craig

Disclosures

Curr Opin Gastroenterol. 2018;34(1):50-56. 

In This Article

Abstract and Introduction

Abstract

Purpose of review. The purpose of this review is to examine the evidence supporting the use of recently developed pharmacological treatments for IBS together with new evidence supporting more traditional therapies in order to understand where the new agents are best used in the treatment pathway.

Recent findings. There is evidence to support the use of traditional treatments such as antispasmodics, antidepressants and dietary alteration in IBS. New therapeutic agents such as Linaclotide, Lubiprostone, Plecanatide, Rifaxamin and Eluxadoline are all more effective than placebo in treating symptoms of IBS with Tenapanor being a promising new agent. The majority of patients, however, treated with these medications remain symptomatic and they are not suitable for use in all patients.

Summary. Traditional treatments such as antispasmodics, antidepressants, dietary and lifestyle modifications retain their importance in the treatment of IBS with the newer agents to be considered wherever these treatments are ineffective or poorly tolerated.

Introduction

Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract characterized by recurrent abdominal pain associated with defecation or a change in bowel pattern. Bloating and abdominal distention and a disordered bowel habit are typically present.[1] It affects 10–15% of the population in Europe[2] and North America[3] and 5–10% in Asia.[4] Although only 15% of those affected seek medical attention[5] up to two-thirds of these will see a gastroenterologist at some point[6] and as such IBS is one of the most common referrals to gastroenterology.[7]

Like all functional gastrointestinal disorders, IBS is increasingly described as a disorder of brain–gut interaction. Abnormalities in motility, visceral hypersensitivity, mucosal inflammation, impaired barrier function, changes in the microbiome and abnormal central nervous system processing are all purported to play a role in its complex pathophysiology.[8]

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