Irritable bowel syndrome: rational therapy

Irritable bowel syndrome (IBS) is characterized by abdominal pain or discomfort, bloating, and constipation or diarrhea; the pain is typically relieved by defecation. The diagnosis is not one of exclusion; it can be made based on the answers to a few key questions and the absence of “alarm” symptoms.Judicious use of fiber supplements, the elimination of particular foods, and regulation of bowel function can help relieve symptoms. Polyethylene glycol or lubiprostone can be used to treat IBS with constipation. Loperamide (and if symptoms are severe, alosetron) are of benefit in IBS with diarrhea (although alosetron carries a small risk of ischemic colitis and severe constipation). Antidepressants (both tricyclics and selective serotonin reuptake inhibitors) may be used to treat IBS. Probiotic therapy or rifaximin may help reduce IBS symptoms including bloating