Management of irritable bowel syndrome with diarrhea: focus on eluxadoline

Curr Med Res Opin. 2021 Feb 10;1. doi: 10.1080/03007995.2021.1888705. Online ahead of print.

Jennifer Jones 1, Anthony Lembo 2, Joel Heidelbaugh 3, Louis Kuritzky 4, Lacy Brian 5


Author information

  • 1UCF College of Medicine, HCA Consortium Family Medicine Residency, Gainesville, FL, USA.
  • 2Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
  • 3Departments of Family Medicine and Urology, University of Michigan Medical School, Ann Arbor, MI, USA.
  • 4Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.
  • 5Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA.


Objective: We sought to summarize current recommendations for the diagnosis of diarrhea-predominant irritable bowel syndrome (IBS-D) and describe available management options, highlighting a newer US Food and Drug Administration (FDA)-approved agent, eluxadoline.

Methods: Literature on IBS-D was assessed up to January 2020 using PubMed, with key search terms including 'IBS-D diagnosis', 'IBS-D management', and 'eluxadoline'.

Results: IBS is a common gastrointestinal disorder affecting up to 14% of US adults and is particularly prevalent in women and those aged under 50. Symptoms include abdominal pain associated with altered bowel habits (i.e. diarrhea and/or constipation subtyped based on the predominant stool pattern). As IBS-D is challenging to manage with varying symptom severity, effective treatment requires a personalized management approach. Evidence-based therapeutic options endorsed by the American Gastroenterological Association and the American College of Gastroenterology can be used to effectively guide treatment. Dietary and lifestyle modifications, including adequate hydration, reducing caffeine and alcohol intake, and increasing soluble fiber intake may lead to symptom improvement. Over-the-counter medications such as loperamide are frequently recommended and may improve stool frequency and rectal urgency; however, for the outcome of abdominal pain, mixed results have been observed. Several off-label prescription medications are useful in IBS-D management, including tricyclic antidepressants, bile acid sequestrants, and antispasmodics. Three prescription medications have been approved by the FDA for IBS-D: alosetron, eluxadoline, and rifaximin.

Conclusions: IBS-D can be effectively managed in the primary care setting in the absence of alarm features. Benefits and risks of pharmacologic interventions should be weighed during treatment selection.

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