Table 9. IBS Treatment Options for Global Symptoms and/or Overall Well-being
Treatment
Cognitive behavioral therapy
Dynamic psychotherapy Hypnotherapy
Key Points Psychological and behavioral therapy (1B)
• Modifies maladaptive behaviors and thoughts • Improves global IBS symptoms
• Improves global IBS symptoms • Improves global IBS symptoms
Complementary alternative medicine Acupuncture
Chinese herbal therapy
• Improvement in IBS symptoms has not been shown in controlled trials
• Data on efficacy in IBS is limited
Table 10. Treatment Options for IBS-D Drug (Brand) Dose Antidiarrheals
Loperamide (eg, Imodium®
) 5-HT3 )
Diphenoxylate (eg, Lomotil®
antagonist
Alosetron (Lotronex®
)
0.5-1.0 mg bid (2A-female, 2B-male)
• Efficacious for IBS-D • FDA approved only through a risk management program for women with severe IBS-D who have not responded to conventional therapies
• Concerns of serious complications of constipation and ischemic colitis (2A)
Tricyclic antidepressants (See Table 7) Gut-selective antibiotic
Rifaximin (Xifaxan®
) 400-550 mg tid (1B)
• Global efficacy demonstrated in nonconstipating IBS
• Improvement in bloating also demonstrated
2 mg daily to 4 mg qid prn; also available as liquid (2C)
5 mg ≤ qid (with atropine) Key Points
• Useful for the treatment of diarrhea but no global symptom relief shown
• Titrate dose to desired effect and avoid constipation
