Gut Liver.  2011 Sep;5(3):253-266.

Pharmacologic and Complementary and Alternative Medicine Therapies for Irritable Bowel Syndrome

• Chey WD
• Maneerattaporn M
• Saad R

Abstract

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by episodic abdominal pain or discomfort in association with altered bowel habits (diarrhea and/or constipation). Other gastrointestinal symptoms, such as bloating and flatulence, are also common. A variety of factors are believed to play a role in the development of IBS symptoms, including altered bowel motility, visceral hypersensitivity, psychosocial stressors, altered brain-gut interactions, immune activation/low grade inflammation, alterations in the gut microbiome, and genetic factors. In the absence of biomarkers that can distinguish between IBS subgroups on the basis of pathophysiology, treatment of this condition is predicated upon a patient's most bothersome symptoms. In clinical trials, effective therapies have only offered a therapeutic gain over placebos of 7-15%. Evidence based therapies for the global symptoms of constipation predominant IBS (IBS-C) include lubiprostone and tegaserod; evidence based therapies for the global symptoms of diarrhea predominant IBS (IBS-D) include the probiotic Bifidobacter infantis, the nonabsorbable antibiotic rifaximin, and alosetron. Additionally, there is persuasive evidence to suggest that selected antispasmodics and antidepressants are of benefit for the treatment of abdominal pain in IBS patients. Finally, several emerging therapies with novel mechanisms of action are in development. Complementary and alternative medicine therapies including probiotics, herbal therapies and acupuncture are gaining popularity among IBS sufferers, although concerns regarding manufacturing standards and the paucity of high quality efficacy and safety data remain.

Keyword

Serotonin; Chloride secretogogues; Antibiotics; Antidepressants; Probiotics

MeSH Terms

Abdominal Pain
Acupuncture
Alprostadil
Anti-Bacterial Agents
Antidepressive Agents
Carbolines
Complementary Therapies
Constipation
Diarrhea
Flatulence
Gastrointestinal Diseases
Humans
Hypersensitivity
Inflammation
Irritable Bowel Syndrome
Metagenome
Parasympatholytics
Placebos
Probiotics
Rifamycins
Serotonin
Biomarkers
Lubiprostone
Alprostadil
Anti-Bacterial Agents
Antidepressive Agents
Carbolines
Parasympatholytics
Placebos
Rifamycins
Serotonin