New Guidelines Issued for Management of IBS

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The new guidelines encompass existing evidence on conventional treatments for IBS as well as new therapies (probiotics, for example) and alternative therapies (acupuncture and more). In summary, the updated guidelines say:

• Fiber products -- including psyllium, anti-spasmodic medications and peppermint oil -- may be effective, at least in some people. "The evidence is poor, but some patients say they feel better," Brandt said. He cautioned that fiber should be used carefully in people with narrowed colons.
• More data is needed on probiotics, live microorganisms (usually bacteria) similar to the "good" organisms found normally in the gut. "This is a very hot topic but an exceedingly complicated subject," Brandt said. Researchers and practitioners need to consider the species of bacteria used, how many species, and dosages.
• Non-absorbable antibiotics -- those targeted to the gut only, such as rifaximin (Xifaxan) -- also seem to help some people, especially those who have "diarrhea-predominant IBS." Brandt said that "the data is not great, but some patients swear they're helping them dramatically."
• Tricyclic antidepressants as well as the antidepressants known as selective serotonin reuptake inhibitors (SSRIs) benefit a broad range of people with IBS. This is backed up by quality studies, although with small numbers of participants, and could change as research on larger numbers of people is evaluated. Psychological counseling may also provide some relief.
• Selective C-2 chloride channel activators, notably lubiprostone (Amitiza), are effective for "constipation-predominant IBS."
• 5HT 3 antagonists such as alosetron (Lotronex) relieve symptoms of diarrhea but can cause constipation and colon ischemia, a restriction of blood flow.
• 5HT 4 agonists, though effective against constipation, are not available in North America because of a heightened risk of cardiovascular problems.
• There is yet to be conclusive evidence on Chinese herbal mixtures, and the mixtures run the risk of causing liver failure and other problems. Differences in the content of compounds and the purity of ingredients complicate evaluation of benefits.
• Similarly, the evidence on acupuncture remains inconclusive.
• There is no evidence at this point that testing for food allergies or following diets that exclude certain foods alleviates IBS symptoms.
• Routine diagnostic testing for IBS is not recommended, although some testing should be performed in certain subgroups of patients.

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