Traditional symptom-based
therapies of
irritable bowel syndrome (IBS) are directed at the relief of individual IBS symptoms, but they are often of limited efficacy in addressing the entire symptom complex. Combinations of drugs to target bothersome symptoms are suggested as the first-line pharmacologic treatment. Increasing knowledge of the pathophysiology and molecular mechanisms of IBS has resulted in the development of several new therapeutic approaches. Thirteen consensus statements for the treatment of IBS were developed using the modified Delphi approach. Exclusion diets have modest efficacy in improving symptoms in some IBS patients. Symptom-based
therapies with
dietary fiber, bulking agents, laxatives,
antispasmodics and laxatives are effective in the improvement of some individual symptoms, e.g.
dietary fiber and bulking agents for
constipation, laxatives for
constipation,
antispasmodics for
abdominal pain and discomfort,
antidiarrheals for
diarrhea. 5HT3 receptor antagonists and 5HT((4)) receptor agonists are effective in the relief of global IBS symptoms and individual symptoms such as
abdominal pain and abnormal bowel habits. A short term course of nonabsorbable
antibiotics may improve global IBS symptoms, particularly in patients with
diarrhea- predominant IBS. Some probiotics appear to have the potential benefit in improving global IBS symptoms. Selective C-2
chloride channel activator is more effective than placebo at relieving global IBS symptoms in patients with
constipation-predominant IBS. Both
tricyclic antidepressants and
selective serotonin reuptake inhibitors are equally effective in relieving global IBS symptoms, and have some benefits in treating
abdominal pain. Certain types of psychologic
therapy may be effective in improving global symptoms in some IBS patients. Further studies are strongly needed to develop better treatment strategies for Korean patients with IBS.