Irritable bowel syndrome management

Irritable bowel syndrome management

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits in the absence of specific or identifiable organic pathology.

Subtypes of IBS

1. IBS-D – Diarrhea-predominant IBS

2. IBS-C – Constipation-predominant IBS

3. IBS-M – Mixed IBS (alternating diarrhea and constipation)

4. IBS-U – Unclassified IBS (symptoms do not fit the above categories)

Clinical presentation

Diagnostic symptoms

Recurrent abdominal pain or discomfort occurring at least 3 days per month during the last 3 months, associated with two or more of the following:

• Improvement with defecation

• Onset associated with a change in stool frequency

• Onset associated with a change in stool form (appearance)

Additional symptoms

• Bloating

• Sensation of abdominal fullness

Non-pharmacological treatment

Counseling, lifestyle modification, identification and avoidance of trigger factors, reassurance, and management of psychosocial factors are the cornerstone of long-term treatment.

Supportive measures

• High-fiber diet

• Healthy eating habits

• Lifestyle modification

• Avoidance of known dietary and environmental triggers

Pharmacological treatment

Antispasmodic therapy

Hyoscine butylbromide

• Hyoscine butylbromide (PO) 10 mg 6 hourly when required

OR

Mebeverine

• Mebeverine (PO) 135 mg 8 hourly when required

Neuromodulator therapy

Amitriptyline

• Amitriptyline (PO) 25 mg nocte for 1 week

• Then 50 mg nocte during weeks 2–4

Management of constipation-predominant IBS (IBS-C)

Osmotic laxative

Lactulose

• Lactulose (PO) 20 mL 12 hourly when required

OR

Stimulant laxative

Bisacodyl

• Bisacodyl (PO) 5–15 mg when required

Management of diarrhea-predominant IBS (IBS-D)

Antidiarrheal therapy

Loperamide

• Loperamide (PO) 4 mg stat

• Followed by 2 mg 8 hourly or after each unformed stool until diarrhea is controlled