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IBS Treatments: What Are My Options?

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If you have irritable bowel syndrome (IBS), you may have already gone through some of the more traditional therapies like fiber supplements, the low FODMAP diet, or pain medications like Bentyl. But did you know there are a number of non-traditional IBS treatment options available to you, as well? We researched what the current evidence says, so you don’t need to. Read on to find out if there are benefits behind things like antibiotics, probiotics, antidepressants, gut-directed hypnotherapy, and yoga!

 

Antibiotics 

Research over the past ten years has suggested the important role gut flora plays in irritable bowel syndrome (IBS) patients. There are numerous theories as to what causes IBS, one such being bacteria or bacterial infection. Evidence of the involvement of bacteria in IBS provides a rationale for the potential therapeutic benefit of antibiotic treatment.

Several broad-spectrum absorbable antibiotics have successfully reduced overgrowth: tetracycline, amoxicillin-clavulanate (Augmentin), metronidazole (Flagyl), and fluoroquinolones (such as norfloxacin), however, these antibiotics can come with side effects (1). 

Rifaximin has shown the most promise in reducing IBS-D symptoms, or diarrhea-predominant IBS. In two identically designed, double-blind, placebo-controlled trials patients who had IBS without constipation were randomly assigned to either rifaximin at a dose of 550 mg or placebo, three times daily for 2 weeks, and were followed for an additional 10 weeks. Those in the Rifaximin group experienced significant relief in global IBS symptoms as well as reported a decrease in bloating compared to the placebo group. It was found that treatment with Rifaximin for 2 weeks provided significant relief of IBS symptoms, bloating, abdominal pain, and diarrhea (2). 

The recent American College of Gastroenterology (ACG) guidelines now recommend rifaximin as a first-line treatment for those experiencing IBS-D (3). 

 

Antidepressants

Antidepressants have been studied to have a positive effect on gut motility, visceral hypersensitivity, and GI transit speed. The beneficial effects come from the action these medications have on neurotransmitters found in the brain and the gut, especially on acetylcholine, serotonin, norepinephrine, and dopamine (say that three times fast!). 

Tricyclic antidepressants (TCAS) are the most commonly studied antidepressant for the use of IBS symptom treatment. Studies have shown that they slow down gut motility, which helps to prevent diarrhea (4). A 2009 meta-analysis examining seven studies, concluded that low dose TCAs exhibit clinically and statistically significant control of IBS symptoms (5). The current ACG guidelines also recommend the use of TCAs as first-line therapy. So, are there any other antidepressants that may have a benefit? Studies have also looked at selective serotonin reuptake inhibitors (SSRIs), primarily for constipation, due to their ability to speed up gut transit. However, they were found to be less effective than TCAs are not typically recommended as first-line therapy (6).

 

Gut-directed hypnotherapy

You may have heard about gut-directed hypnotherapy from your GI doctor, or maybe you’ve seen an ad for an app pop up on your Instagram. But, is there any validity in it? There sure is! A 2016 study compared gut-directed hypnotherapy with the low FODMAP diet and the results were exciting. What they found was that the therapy was just as effective in reducing IBS symptoms as the low FODMAP group. This suggests specific psychological benefits, not just improvements associated with lower severity of gastrointestinal symptoms (7). 

While the exact mechanisms of gut-directed hypnotherapy aren’t yet well understood, there’s evidence that it can influence positive outcomes for IBS patients. However, there are limitations. Patients must be very compliant and consistent with their therapy in order to maintain the benefit. 

 

Probiotics 

Probiotics are always a hot topic in irritable bowel syndrome (IBS) and gut health in general. Unfortunately, we still do not have enough consistent evidence to suggest the use of probiotics to treat IBS symptoms. 

 

Yoga 

We still don’t know all of the exact causes of irritable bowel syndrome (IBS), but anyone with this chronic illness can tell you that stress can surely exacerbate symptoms.  Yoga has been studied in conjunction with stress management to improve the gut-brain axis connection and restore the gut microbiota. This may be because yoga offers the possibility of reducing inappropriate activation of the autonomic nervous system (ANS). Clinical trials on IBS patients have shown abnormalities in autonomic function and psychological profiles, therefore, proving that yoga can help IBS patients (8). 

A 2015 study looked at the effects of yoga on irritable bowel syndrome (IBS) symptoms and quality of life. The 12-week randomized control trial had three study groups: One group received limited conventional treatment + yoga (yoga group), the second group received conventional treatment + yoga (combination group), and the third was a control group. The yoga group and the combination group both showed significant improvements in IBS as well as an increase in quality of life scores compared to the control group (9).

Irritable bowel syndrome (IBS) therapies have certainly come a long way in the past 10-15 years! If you’re interested in trying any of these therapies, or just finding out more information, reach out to your healthcare team to discuss your options. 

 

References

  1. Basseri, R. J., Weitsman, S., Barlow, G. M., & Pimentel, M. (2011). Antibiotics for the treatment of irritable bowel syndrome. Gastroenterology & hepatology, 7(7), 455–493.
  2.  Pimentel, M., Lembo, A., Chey, W. D., Zakko, S., Ringel, Y., Yu, J., Mareya, S. M., Shaw, A. L., Bortey, E., Forbes, W. P., & TARGET Study Group (2011). Rifaximin therapy for patients with irritable bowel syndrome without constipation. The New England journal of medicine, 364(1), 22–32. https://doi.org/10.1056/NEJMoa1004409.
  3. Lacy, B. E., Pimentel, M., Brenner, D. M., Chey, W. D., Keefer, L. A., Long, M. D., & Moshiree, B. (2021). ACG Clinical Guideline: Management of Irritable Bowel Syndrome. The American journal of gastroenterology, 116(1), 17–44. https://doi.org/10.14309/ajg.0000000000001036.
  4. Clouse R. E. (2003). Antidepressants for irritable bowel syndrome. Gut, 52(4), 598–599. https://doi.org/10.1136/gut.52.4.598.
  5. Rahimi, R., Nikfar, S., Rezaie, A., & Abdollahi, M. (2009). Efficacy of tricyclic antidepressants in irritable bowel syndrome: a meta-analysis. World journal of gastroenterology, 15(13), 1548–1553. https://doi.org/10.3748/wjg.15.1548.
  6. Ford, Alexander C. MB ChB, MD, FRCP1; Moayyedi, Paul BSc, MB ChB, PhD, MPH, FACG, FRCP, FRCPC, AGAF2; Chey, William D. MD, FACG, AGAF, FACP3; Harris, Lucinda A. MD, FACG4; Lacy, Brian E. MD, PhD, FACG5; Saito, Yuri A. MD, MPH, FACG6; Quigley, Eamonn M. M. MD, MACG, FRCP, FACP, FRCPI7 for the ACG Task Force on Management of Irritable Bowel Syndrome American College of Gastroenterology Monograph on Management of Irritable Bowel Syndrome, American Journal of Gastroenterology: June 2018 - Volume 113 - Issue - p 1-18 doi: 10.1038/s41395-018-0084-x
  7. Peters, S. L., Yao, C. K., Philpott, H., Yelland, G. W., Muir, J. G., & Gibson, P. R. (2016, July 11). Randomized clinical trial: The efficacy OF gut‐directed Hypnotherapy is similar to that of the low FODMAP diet for the treatment of irritable bowel syndrome. Wiley Online Library. https://onlinelibrary.wiley.com/doi/10.1111/apt.13706. 
  8. Kavuri, V., Raghuram, N., Malamud, A., & Selvan, S. R. (2015). Irritable Bowel Syndrome: Yoga as Remedial Therapy. Evidence-based complementary and alternative medicine : eCAM, 2015, 398156. https://doi.org/10.1155/2015/398156.
  9. Vijaya Kavuri, Pooja Selvan, Ariel Malamud, Nagarathna Raghuram, Senthamil R. Selvan, Remedial yoga module remarkably improves symptoms in irritable bowel syndrome patients: A 12-week randomized controlled trial, European Journal of Integrative Medicine, Volume 7, Issue 6, 2015, Pages 595-608, ISSN 1876-3820, https://doi.org/10.1016/j.eujim.2015.11.001.
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About Author

Liz McMahon, RDN, LDN
Liz McMahon, RDN, LDN

Liz is a Registered Dietitian who focuses on digestive health. She has completed FODMAP training through Monash University and loves seeing the benefit her IBS patients have with this diet! Liz has been in the nutrition field for over 10 years, working at a top hospital in Philadelphia as a Clinical Dietitian for the past 5 years. She also runs her own private practice, Liz McMahon Nutrition, where she provides virtual nutrition counseling to clients with a range of gastrointestinal disorders.

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