Managing Irritable Bowel Syndrome (IBS): Effective Treatments, Dietary Tips, and Lifestyle Strategies - Dr Arun P

Irritable bowel syndrome (IBS) is a highly prevalent, chronic disorder that significantly reduces a patient's quality of life. It’s a disorder of gut-brain interaction. IBS is characterized by symptoms of recurrent abdominal pain and disordered defecation.

IBS can be subclassified into: IBS with diarrhoea (IBS-D), IBS with constipation (IBS-C), and IBS with mixed bowel patterns (IBS-M).

The elimination of dietary fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) has been a treatment for patients with IBS. FODMAPs lead to increased GI water secretion and increased fermentation in the colon, thus producing short-chain fatty acids and gases, which can lead to luminal distension and the triggering of meal-related symptoms in patients with IBS.

Most of the trials also reported benefits of the low FODMAP diet for individuals with IBS symptoms, particularly abdominal pain and bloating. Avoid dairy products, caffeinated drinks etc.

The low FODMAP diet is given as:- the first stage is substitution of foods with low FODMAP choices; the second stage is a gradual reintroduction of foods into the diet while assessing symptoms; the third stage is personalization of the diet to avoid foods that trigger symptoms.

Almost all the available research has focused on FODMAP restriction. However, responders to restriction of FODMAPs can be identified in 2–6 weeks. Patients with IBS are advised to exclude food that increase flatulence (e.g., beans, onion, celery, carrots, raisins, bananas, apricots, prunes, Brussels sprouts, wheat germ etc).

Dietary fibre is frequently recommended to improve symptoms in patients with IBS, particularly when constipation is the predominant complaint. Soluble, viscous, poorly fermentable fibre may provide benefits in IBS.

The apparent lack of significant side effects makes fibre a reasonable first line therapy for IBS patients with symptoms. The ability to improve stool viscosity and frequency logically argues for the use of fibre in patients with IBS-C.

Physical activity is advised in patients with IBS, given a potential benefit with regard to IBS symptoms and the general health benefits of exercise. With respect to gastrointestinal symptoms, exercise can accelerate gastrointestinal transit, improve intestinal gas clearance in patients with bloating and might increase gut microbial diversity, with the potential to positively impact symptoms via the gut-brain axis.

Peppermint (Mentha piperita) is a popular natural/herbal remedy for IBS. Although the clinical benefits of peppermint oil for patients with IBS have most often been attributed to L-menthol's blockade of calcium channels and attendant smooth muscle relaxation.

Lubiprostone is US FDA-approved for the treatment of adult women with IBS-C at a dosage of 8 μg twice daily. Rifaximin is a nonabsorbed antibiotic which is US FDA-approved for the treatment of patients with IBS-D. Rifaximin treatment is based on the hypothesis that a portion of patients with IBS-D have an abnormal microbiome.

Tricyclic antidepressants (TCA) are believed to improve visceral pain and central pain by acting on norepinephrine, and dopaminergic receptors, thus making them attractive candidates for the treatment of IBS-related abdominal pain.

TCAs may also improve abdominal pain because of their anticholinergic effects and, at higher doses, can also slow GI transit, thereby improving symptoms of diarrhoea in some patients.

Patients with unrelenting symptoms that are associated with psychiatric impairment may benefit from behavioural modification in conjunction with antidepressants.

Psychological interventions either with pharmacotherapy or cognitive behaviour therapy, gut-directed hypnotherapy, yoga are useful options to treat these patients in addition to standard treatment.

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