The American College of Gastroenterology recently released a review of the data for the management of irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC).
Patients with IBS experience issues such as abdominal pain, constipation, and frequent diarrhea. Unlike inflammatory bowel disease (IBD) conditions such as Crohn’s, IBS does not involve changes to the structure of the bowel but is a”functional” problem, how the digestive tract functions- motility and sensitivity are affected; hence most diagnostic tests such as X-rays may be normal. In most cases, the exact cause is not known. Similarly, chronic idiopathic constipation refers to constipation without a known cause.
Patients with these conditions are often frustrated by the challenges associated with understanding the condition and controlling the symptoms. The new American College of Gastroenterology guidelines have the potential to help doctors implement treatments that have the most evidence.
Some of the most recommended treatments include:
- Fiber, especially psyllium fiber as opposed to bran fiber
- Probiotics, including live culture yogurt, to treat bloating and flatulence
- Rifaxamin for cases that include diarrhea
- Linaclotide and lubiprostone for cases that cause constipation
- Antidepressants and psychological treatment show promise, but do not have strong evidence; also, access may be limited
The report recommended more therapeutic trials for the low-FODMAP diet, which eliminates foods containing simple carbohydrates and alcohol. The diet shows promise, but no large clinical trials have been performed.
On the other hand, the report concluded that certain treatments sometimes recommended for the treatment of IBS need strong evidence before they can be recommended. Treatments that require stronger evidence include elimination diets and prebiotics. Although it is possible that these treatments may benefit some cases, the evidence is not clear enough to recommend their use or to recommend their disuse.
Chronic Constipation Recommendations
The report strongly recommended several treatments for CIC. Fiber supplements, laxatives, prucalopride, lubiprostone, and linaclotide are all strongly recommended for the treatment of chronic constipation. These treatments may be used either on their own or in conjunction with one another.
The recommendations from the American College of Gastroenterology are valuable in helping doctors and patients understand which treatments have the most evidence behind them. However, each patient responds to treatment differently, and a course of treatment that works for one patient may not work for another. The management of conditions like IBS and CIC is generally a matter of introducing treatments and evaluating their effectiveness, under the guidance of a doctor.
All of these treatments are not appropriate for everyone. Depending on the type and severity of your symptoms, your gastroenterologist can determine the most appropriate treatment for you. For example, most patients start eating a high fiber diet for IBS, but this may contain foods with high FODMAPS, that may in turn cause worsening of their symptoms. Similarly, if you already have constipation, in some cases fiber may make it worse, unless combined with a gentle laxative. You need a “customized” treatment plan, also depending on your response to certain medications and based on certain tests that identify motility problems, etc.