New IBS Guidelines Offer Treatment Ideas

American College of Gastroenterology Updates Recommendations for Irritable Bowel Syndrome

By Bill Hendrick
WebMD Health News

Reviewed By Louise Chang, MD

Dec. 19, 2008 -- New guidelines have been issued by the nation's gastroenterologists that are aimed at easing the abdominal pain, diarrhea, and other symptoms of irritable bowel syndrome (IBS), which afflicts millions of Americans.

The guidelines, issued by the American College of Gastroenterology, also offer hope to patients who've struggled with the condition and found satisfactory treatments lacking.

IBS is diagnosed in people whose symptoms include abdominal pain, bloating, gas, diarrhea, and constipation, or a combination of these symptoms. Though sometimes confused with inflammatory bowel disease, which includes Crohn's disease and ulcerative colitis, IBS is a separate condition.

IBS care uses up more than $20 billion a year in direct and indirect expenditures, according to William Chey, MD, professor of medicine and director of the Gastrointestinal Physiology Laboratory at the University of Michigan Health System. He developed the guidelines in conjunction with Philip Schoenfeld, MD.

"The last time the American College of Gastroenterology published guidelines for the management of IBS was in 2002, and the College recognized that in the span of five to six years there has been a remarkable explosion in knowledge that's become available that's helped us to understand the cause and management of IBS," Chey says in a news release.

Tests and Treatments for IBS

According to the new guidelines:

• Patients with symptoms typical for IBS -- and without alarm features like weight loss, or a family history of colon cancer, IBD, or celiac disease -- do not need extensive testing before being diagnosed.
• IBS patients with diarrhea, or a combination of constipation and diarrhea, should be screened with blood tests for celiac disease, a disorder in which patients can't tolerate the gluten protein found in wheat or other grains.
• When IBS patients have alarm features or are over 50 years old, they should have further tests (such as colonoscopy) to rule out other bowel disease such as IBD and colon cancer.
• IBS patients and their doctors should consider treatments involving antidepressants, which have been shown to offer relief.
• The drug Amitiza helps with women who have IBS with constipation; the non-absorbable antibiotic rifaximin can ease IBS and bloating as a short-term treatment. And Lotronex, a drug that affects serotonin receptors, can be considered for patients with severe IBS with diarrhea.
• Certain anti-spasm treatments may offer short-term help with abdominal pain from IBS. These include hyoscine, cimetropium, and peppermint oil.
• A probiotic called Bifidobacteria may help some IBS patients.

According to the guidelines, women are twice as likely as men to suffer from IBS, which often begins in young adulthood. Gastroenterologists have found that dietary changes have proved helpful, including the addition of dietary fiber supplements such as psyllium.

Chey says IBS can be managed in most patients with counseling, dietary and lifestyle interventions, and use of both over-the-counter and prescription medications.

The guidelines suggest many treatments might be tried, though the authors concede no single magical answer has yet been found to eliminate symptoms in IBS patients. But the guidelines offer hope for people with IBS that their doctors can try a number of methods to reduce discomfort, and that some of the steps that can be taken seem to work.

SOURCES: News release, University of Michigan Health System. Brandt. L. American Journal of Gastroenterology, January 2009; vol 104.

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