Therapy of Irritable Bowel Syndrome

Irritable bowel syndrome won't kill you... yet it will make you wish it did...at times

Here are some of the known facts of Irritable Bowel Syndrome (IBS)
-It is a chronic condition that can lasts months and years sometimes forever
-It has no known cure

When there are variations in symptoms it is important to find out if there is a change in
- Stress level
- New medications
- New food
- Concerns about serious illness
- Sleep issues
- Psychiatric issues
- Request for pain medications

Therapy:
1. Establishment of a relationship between caregiver and the patient
2. Lactose restricted diet
3. Fructose restricted diet
4. In people who complain of gas and bloating avoid beans, onions, celery, carrots, raisins, bananas, apricots, prunes, brussel sprouts, whole wheat, pretzels and baegels
5. Role of food allergy testing is not well established
6. Some patients are helped by fiber, others are not. It is always prudent to avoid insoluble fiber such that those in whole wheat and wheat bran. Synthetic fibers such as metamucil are better tolerated than insoluble fiber
7. Behavorial therapy such as hypnosis, biofeedback and psychotherapy help with IBS

Drugs in IBS-
- Avoid long term pain medications which aggravate the root problem
- Avoid chronic medications
Dicyclomine 20 mg 4 times a day PRN
Hyoscyamine 0.125 to 0.25 mg sub lingual 4 times a day PRN
Antidepressants
Antidiarrheal agents
Benzodiazepines
Lubiprostone for constipation and loperamide for diarrhea
Alternative therapies - not well established

Mild symptoms- still able to function almost normally without any psychological impairment
- Patient education, reassurance, dietary modification and fiber

Moderate symptoms- experience daily disruptions with symptoms and may have psychological problems
- Avoid lactose, artificial sweetners
- Avoid caffiene
- behavorial changes and psychotherapy
- Tricyclics and pharmacological agents

Intractable symptoms- tertiary care centers