New Therapies in Irritable Bowel Syndrome: What Works and When

Orla Craig


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

In This Article

First-line Therapy

In terms of medical therapy, the usual approach has been to start an antispasmodic together with a laxative or an antidiarrhoeal depending on the predominant bowel pattern. Antispasmodics in general and specifically hyoscine and peppermint oil have been shown to improve IBS symptoms in meta-analytic studies.[24] They seem to work by reducing colonic contractions and transit time thereby improving both the pain and diarrhoea associated with IBS.[33] A recent small randomized controlled trial has shown that a novel enteric coated peppermint oil formulation (IBgard) designed for sustained release in the small intestine had a positive effect on overall IBS symptoms as well as individual symptoms such as pain, bloating abdominal distension and urgency.[34] Soluble fibre such as psyllium[24] and polyethylene glycol[35] are of proven benefit in the management of constipation predominant Irritable Bowel Syndrome (IBS-C). Both are cheap, widely available and unlikely to be associated with serious side effects, as such they remain first-line treatment for the management of IBS. They have, however, minimal effects on abdominal pain and leave many patients dissatisfied as a result. Similarly, Loperamide a μ-opiate receptor agonist is useful in the management of diarrhoea predominant Irritable Bowel Syndrome (IBS-D). It decreases colonic transit, and increases water and ion absorption resulting in positive effects on stool frequency and consistency as well as urgency but its effect on other symptoms is negligible.[36]