Most Effective Treatments for IBS (April 2009)

Now that spring has arrived, it is a great time to enjoy outdoor activities such as gardening, hiking and biking. Unfortunately for some, symptoms of Irritable Bowel Syndrome (IBS) can pose a real interference with these otherwise exciting activities.

Two articles discussing the medical management of IBS(1,2) will serve as the focus for this month’s discussion. Both of these articles were published in the January 2009 issue of the American Journal of Gastroenterology.

The articles discuss the conclusions of a panel that was formed to update medical recommendations with regard to the management of IBS. As the basis for these updated recommendations, medical research literature published from 2002 to present was collected, reviewed and analyzed.

The panel evaluated the effectiveness of numerous medical treatments based on the quality of clinical trials within the research literature. The treatments reviewed by the panel, and the panel’s conclusions are as follows.

Diets: There was insufficient evidence that food allergy testing or exclusion diets were beneficial in treating patients with IBS.

Dietary fiber, bulking agents and laxatives: Psyllium or products like Metamucil were moderately effective. Wheat bran or corn bran were not helpful. Polyethlene glycol laxatives like Miralax improved stool frequency but did not ease abdominal pain.

Antispasmodic agents: Medications that inhibit intestinal motility like Librax and Levsin can provide short-term relief of abdominal pain in IBS. These are prescription medications with side effects like dry mouth and sleepiness that can limit their tolerability.

Antidiarrheal agents: Imodium was not found to be more effective than placebo at reducing the IBS symptoms of pain and bloating.   It was effective at reducing diarrhea and improving stool consistency. 

Antibiotics: A nonabsorbable antibiotic, rifaximin, was effective in improving the symptoms of bloating, gas and diarrhea in patients with IBS. There are concerns for potential risks in giving antibiotics long-term. The FDA has not approved rifaximin for treatment of IBS.

Probiotics: Interpretation of the available literature is hampered due to differences in the dosage and probiotic bacteria used. The studies do suggest that all probiotic therapies have a trend for being beneficial in IBS. Studies of probiotics using single organisms indicate lactobacilli do not appear effective; bifidobacteria and certain combinations of probiotics demonstrate some effectiveness. Available safety data indicate the probiotics are well tolerated and free from serious side effects.

Serotonin antagonists: Lotronex was found to be effective in easing symptoms in IBS patients with diarrhea. The benefits of taking the medication need to be balanced against the complications of constipation and ischemic colitis.

Selective C-2 chloride channel activators: Lubiprosone or Amitiza has been shown to effectively ease the IBS symptoms of abdominal pain, bloating and constipation in women. Side effects include nausea, diarrhea and abdominal pain.

Antidepressants: Medications like Elavil and Prosac have shown benefit in improving IBS symptoms. The safety of using antidepressants in IBS remains poorly documented. These medications are often associated with side effects like sleepiness.

Psychological therapy:  Cognitive therapy, dynamic psychotherapy and hypnotherapy, but not relaxation therapy, are able to improve the symptoms of IBS.

Herbal therapy:Some herbal therapies seemed to be beneficial, but there are significant concerns about toxicity, especially liver failure.

After reviewing the articles, it seems very sensible to try a combination probiotic that contains bifidobacteria. This form of therapy is without side effects, unlike other forms of IBS therapy.  Additionally, probiotics have no drug interactions and are safe to take with other medications. Lastly, there are no findings that indicate long-term therapy is harmful.

If you have IBS and don’t want to be bothered with symptoms while gardening, try a quality probiotic with Bifidobacteria, like EndoMune.

Eat healthy, exercise and live well!
Dr. Hoberman