Is there a curative treatment?
Currently, there are no curative treatments for IBS; Management is focused on treating the associated symptoms.
Describe the nonpharmacological treatment.
Soluble fiber supplements (e.g., psyllium)
Avoidance of trigger foods (e.g., trial of elimination diet)
Low FODMAP diet: diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols
Consider support of a registered dietician.
Regular physical activity
Stress management (e.g., relaxation techniques)
Patient-centered care, strong therapeutic alliance
Elimination diets that restrict fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (i.e., a low FODMAP diet) should be undertaken with the support of a registered dietitian in order to avoid nutritional deficiencies.
Describe the pharmacotherapy.
Evidence for pharmacological therapy is mixed and recommendations vary between guidelines.
Alternative medications: include alosetron (a selective 5-HT3 receptor antagonist), eluxadoline (opioid agonist/antagonist)
When treating IBS-associated diarrhea, use caution to avoid constipation as an adverse effect, especially in patients with IBS-M or IBS-A.
Polyethylene glycol (PEG)
Tenapanor: a sodium-hydrogen antiporter 3 inhibitor
Tegaserod: a partial 5-HT4 receptor agonist
The following can be considered to treat associated abdominal pain:
Antispasmodics: e.g., dicyclomine, hyoscyamine
Tricyclic antidepressants: e.g., amitriptyline