Treatments of Ibs

INTRODUCTION In recent years, there has been increased interest by physicians and the pharmaceutical industry regarding newer treatments for IBS. Before discussing these new treatments, it is important to consider the overall management strategy in IBS. This is necessary because patients with IBS exhibit a wide spectrum of symptoms of varying frequencies and degrees of severity. There is no one ideal treatment for IBS, and the newer medications may work best for only a subset of patients having this disorder. Therefore, the clinician must first apply certain general management approaches and, following this, treatment choices will depend on the nature (i.e., predominant diarrhea, constipation, or bloating, etc.) and severity (mild, moderate, severe) of the symptoms. The symptoms of IBS may have any of several underlying causes. These can include: (a) abnormal motility (uncoordinated or excessive contractions that can lead to diarrhea, constipation, bloating) (b) visceral hypersensitivity (lower pain threshold of the nerves that can produce abdominal discomfort or pain) resulting from the abnormal motility, stress or infection (c) dysfunction of the brain's ability to regulate these visceral (intestinal) activities. Treatments will vary depending on which of these possibilities are occurring. In general, milder symptoms relate primarily to abnormal motility, often in response to food, activity or stress, and/or visceral hypersensitivity. They are commonly treated symptomatically with pharmacological agents directed at the gut. However, more severe symptoms often relate to dysfunction of the brain-gut regulatory system with associated psychosocial effects, and psychological or behavioral treatments and antidepressants are frequently helpful.