Management and current treatment of irritable bowel syndrome

Abstract

SUMMARY
Treatment of patients with irritable bowel syndrome (IBS)
should be individualised on the basis of patients symptoms
and needs. The management of IBS starts with its
safe diagnosis based on the patients symptoms and a limited
work-up for exclusion of organic diseases. The physician
should always try to establish a good therapeutic relationship
with the patient, explain the benign nature of IBS,
and clarify potential triggering factors for IBS exacerbations.
Dietary and lifestyle changes may help a very small
number of IBS patients with mild symptoms, while highfiber
diets or supplements are recommended only for patients
with severe constipation. Loperamide is the drug of
choice for episodes of diarrhea and/or urgency, while smooth
muscle relaxants may be used for IBS exacerbations with
abdominal pain, bloating and/or distention. Antidepressants
are currently used for the treatment of diarrhea- or
abdominal pain-predominant IBS patients who are refractory
to other forms of drug therapy, while psychological
therapies may help refractory IBS cases, but their availability
is rather limited, their cost high, and their efficacy
unproven. In the future, novel agents, which have resulted
from the better understanding of IBS pathophysiology, may
prove to be more effective and safe therapeutic options for
our IBS patients.
Key words: Irritable bowel syndrome, diet, fiber, loperamide,
smooth muscle relaxants, antidepressants