Digestive Disorders Task Force Issues New Treatment Guidelines

Gastroenterology specialists updated standards of care for irritable bowel syndrome and chronic constipation

(RxWiki News) The right food and medicine can be key to managing irritable bowel syndrome and chronic constipation. Specialists in those diseases recently updated treatment standards for patients with these conditions.

The American College of Gastroenterology has issued new standards based on its evaluation of diets and medicines aimed at easing the symptoms of irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC).

Among other symptoms, IBS is marked by ongoing stomach pain that eases after a bowel movement. CIC is marked by three or fewer bowel movements weekly, lumpy or hard stools and the feeling that a bowel movement is incomplete.

"Ask your gastroenterologist about treatment options for IBS and CIC."

Eamonn M.M. Quigley, MD, FACG, gastroenterology division chief at Houston Methodist Hospital in Texas, was chairman of the gastroenterologist task force that set new care standards for IBS and CIC.

Those standards were based on the task force’s review of several studies of IBS and CIC done in the last five years. All study participants were at least 16 years old.

Using those studies, the task force reached several conclusions about treating IBS.

For instance, they found that food and supplements containing probiotics (bacteria helpful in digestion) improved bloating, gas and other symptoms.

The researchers also noted several medicines that may be useful in IBS treatment.

For example, Rifaximin (brand name Xifaxan) may be moderately effective in easing IBS accompanied by diarrhea, the authors reported. However, the body does not easily absorb that pill.

The study authors suggested Linaclotide (Linzess) and lubiprostone (Amitiza) for easing IBS accompanied by constipation.

Antidepressants and other psychological therapies may also help, the study authors noted. This is partly because depression sometimes accompanies IBS.

Diets designed to help the body eliminate bowel waste may be effective, although there was little evidence to prove that, Dr. Quigley and team wrote.

Fiber supplements didn't help much. For people taking such supplements, however, psyllium (a seed used as a laxative) was more effective than bran, the authors said.

Such antispasmodics (medicines that prevent muscle spasms) as otilonium bromide (sold as Spasmoctyl 40) may provide only short-term relief.

Peppermint oil, which some suggest relaxes bowel muscles, treated symptoms more effectively than a placebo, the researchers noted. Still, limited evidence suggested that peppermint oil was effective.

For CIC treatment, the task force suggested laxatives (such as products containing sodium picosulfate or bisacodyl), prucalopride (Resolor), lubiprostone and linaclotide to ease symptoms.

The standards give doctors evidence-based guidelines for treating CIC and IBS, said task force member Lawrence R. Schiller, MD, FACG, in a press release.

“However, it is important that patients talk with their doctors about their treatment options, as there is no one-size-fits-all approach to managing IBS or chronic constipation," Dr. Schiller said. "It’s also vital that patients not be embarrassed to talk openly about their symptoms with their doctor in order to collaboratively determine the best treatment plan for their individual situation.”

Worldwide, an estimated 5 to 15 percent of people have IBS or CIC, the study authors reported. In the United States, 30 million people have been diagnosed with one of those disorders.

The new standards were published online Aug. 5 in the American Journal of Gastroenterology.

Forest Laboratories, Ironwood Pharmaceuticals, Nestlé Health Science and Prometheus Laboratories funded this study.

Some of the researchers received grants and consulting fees from the National Institutes of Health and several pharmaceutical companies.

Review Date: 
August 5, 2014