New and Emerging Treatment Options for Irritable Bowel Syndrome

Lacy BE1, Chey WD2, Lembo AJ3. Gastroenterol Hepatol (N Y). 2015 Apr;11(4 Suppl
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1Professor of Medicine Geisel School of Medicine at Dartmouth Chief of Gastroenterology and Hepatology Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire. 2Timothy T. Nostrant Professor of Medicine Division of Gastroenterology Director, GI Physiology Laboratory Co-director, Michigan Bowel Control Program University of Michigan Health System Ann Arbor, Michigan. 3Associate Professor of Medicine Harvard Medical School Boston, Massachusetts.


Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder associated with abdominal pain, diarrhea, constipation, or a mix of symptoms. The pathophysiology of IBS is not completely understood but appears to involve genetics, the gut microbiome, immune activation, altered intestinal permeability, and brain-gut interactions. There is no gold standard for diagnosis. Several sets of symptom-based guidelines exist. Treatment strategies for IBS may include both nonpharmacologic and pharmacologic approaches. Lifestyle modifications that aim to improve exercise, sleep, diet, and stress may be warranted. Recent data suggest that a gluten-free diet and a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) may benefit some patients. For patients with diarrhea-predominant IBS, treatment options include the synthetic peripheral μ-opioid receptor agonist loperamide, antispasmodic agents, antidepressants, serotonin 5-HT3 antagonists, and the gut-specific antibiotic rifaximin. Ongoing research is evaluating the use of probiotics. For patients with constipation-predominant IBS, therapeutic strategies may include dietary fiber, laxatives, and the prosecretory agents lubiprostone and linaclotide. Research is continuing to optimize the use of available agents and evaluating new approaches to further improve the care of patients with IBS.

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