Linaclotide: A new drug for the treatment of chronic constipation and irritable bowel syndrome with constipation.
IBS Clinical Trials “Pipeline” Boom in 2023
The report featured over 24 companies and over 24 pipeline drugs for the treatment of IBS. Promising pipeline therapies include Olorinab, Blautix, ORP-101, Rifamycin controlled-release, and several other treatments.
The launch of IBSRELA, a first-in-class NHE3 inhibitor, provides a new treatment option with a novel mechanism of action and impressive efficacy data to address the constipation and multiple abdominal symptoms commonly seen in patients with IBS-C, as demonstrated in the Phase 3 clinical trials.
Linaclotide (Linzess®) and Plecanatide (Trulance®) work by increasing fluid secretion and gut movement. Both have also been shown to reduce abdominal pain by decreasing activity of pain sensing nerves. Both drugs treat overall IBS-C symptoms and are FDA approved for the treatment of IBS-C and CIC.
Two new drugs for IBS – rifaximin, an antibiotic, and eluxadoline, an antagonist and agonist of the δ and µ opioid receptors, respectively – have been approved for use in the United States.
Antispasmodic drugs, which may ease cramping – examples include mebeverine, hyoscine and peppermint oil capsules. Tricyclic antidepressants – These are effective in treating pain, bloating and bowel frequency in IBS. Use of these medications does not mean that IBS is caused by depression or anxiety.
Selective serotonin reuptake inhibitors (SSRIs) like sertraline (Zoloft) and fluoxetine (Prozac) are commonly used to treat anxiety disorders, but they could be helpful for people with anxiety and IBS.
Many antidepressants, antibiotics and even cough medications can trigger IBS symptoms. It is important to discuss options with your doctor before discontinuing prescription medication use because of IBS symptoms. In some cases your doctor may be able to prescribe a different drug, or a different form of the drug.
As with many digestive health issues, diet, exercise and relaxation play an important part in managing chronic conditions, such as IBS. Patients are advised to avoid heavily processed foods (ready meals) and fatty or spicy foods, cut down on caffeine and fizzy or alcoholic drinks, and not to eat too much fruit.
IBS Testing and Diagnosis. There is no gold standard for diagnosing IBS. In diagnosing IBS, it's important to identify all the symptoms present, particularly any “red flags”. Doctors will also need to consider alternative diagnoses for IBS, especially for symptoms that may be shared with other diseases.
IBS Treatments
“Mind, body, soul, and gut health care are all important.” For people suffering from more severe IBS, treatment may include prescription antispasmodic or antidiarrheal medications, or low-dose antidepressants. “The last resort is medication,” says Pasricha.
Probiotics have also proven beneficial in IBS patients by slowing down the transit time of the colon, reducing the average number of bowel movements per day, improving stool consistency, overall symptoms, and above all, the quality of life in these patients.
Refined sugar, fructose and the sugar substitute sorbitol are all common triggers. Chocolate is also a common trigger. Besides avoiding these foods, you should also avoid overeating, drink plenty of water and try eating lots of soluble fiber.
Eating small meals several times per day to reduce bloating. Trying probiotics, kefir, or aloe vera juice to promote healthy digestion. Drinking plenty of water to counteract IBS constipation or diarrhea. Incorporating whole grains, including brown rice, whole wheat pasta, or grainy breads.
This means people with IBS can safely consume a serving of medium-sized firm yellow or green bananas daily without triggering gastrointestinal symptoms. However, ripe bananas, which have higher levels of fermentable carbohydrates called fructans, can trigger IBS symptoms in some people.
Tricyclic antidepressants (TCAs) have been shown to ease pain and slow the movement of food through the digestive system. The American College of Gastroenterology (ACG) recommends their use for IBS-D. An SSRI or SSRI may be prescribed to improve constipation if you have IBS-C, but they aren't recommended by the ACG.
Clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan) can help take the edge off. Usually they're not used for a long time because of the risk of addiction. Other prescription medicines. Three other options work in different ways to improve both diarrhea and belly pain in adults.
The prevalence of psychiatric problems including anxiety, depression, bipolar disorder, suicidal attempt/ideation, and eating disorders was significantly higher in the IBS patient population when compared to the general adult population.
Mesalamine, a 5-aminosalicylic acid is an anti-inflammatory drug and extensively used for treating inflammatory bowel disease. The presence of low-grade inflammation and mucosal immune activation in IBS provides the rationale for using mesalamine in IBS patients.
Anti-cramping medications
These medications are meant to relieve the pain by relaxing the muscles of the intestine. Research suggests that four anti-cramping medications may help: butylscopolamine, cimetropium, pinaverium and otilonium.