Tuesday, September 11, 2012

What works for patients with irritable bowel syndrome?

- Kenny Lin, MD

A lot of treatments do, according to a review article by Thad Wilkins, MD and colleagues in the Sept. 1 issue of American Family Physician. Most effective appear to be regular exercise, antibiotics, antispasmodics, peppermint oil, and probiotics. Less effective (increase stool frequency but not pain) are over-the-counter antidiarrheals and laxatives. Fiber is no more effective than placebo. Other treatments that can provide some benefit include antidepressants, psychological therapies, and lubiprostone. With this many options to choose from, the challenge for physicians is selecting treatments that are most likely to benefit individual patients. The authors suggest classifying irritable bowel syndrome as diarrhea-predominant, constipation-predominant, or mixed presentation to guide initial and subsequent choices. Forming a therapeutic alliance with patients is critical, since IBS symptoms often recur despite treatment, and "a positive patient-physician interaction is associated with fewer return visits for IBS and is a key component in the treatment of these patients." A freely accessible handout for patients summarizes the most common treatments and provides additional informational resources.

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