Irritable bowel syndrome: an update on therapeutic modalities

Irritable bowel syndrome (IBS) is the most common condition that a physicia n faces in the GI clinic. Of the general population, 10-25% suffer from sym ptoms judged to be IBS. The negative impact of this disease includes not on ly pain, suffering and direct medical expenses but also significant social and job-related consequences. IBS can be the result of dysfunction in any p art of the brain-gut axis: alterations in the CNS caused by psychological o r other factors, abnormal gastrointestinal motility, or heightened visceral sensations. Diagnosis is based on either the Manning or Rome-II criteria. Education, reassurance and emotional support are the cornerstones of succes sful treatment. The mainstays of the current therapeutic approach continue to be: stress management strategies, dietary modification entailing additio n of dietary fibre and pharmacotherapy. Pharmacotherapy is still limited to treating symptoms. Newer drugs that modulate motility or drugs that modula te visceral sensation may be useful in selected cases. Psychopharmacologica l agents are useful in the treatment of IBS, especially in those with psych ological co-morbidity. Alternative therapies such as homeopathy, acupunctur e, special diets, herbal medication and several forms of psychological trea tments and hypnotherapy are sought by many patients and are now being offer ed by physicians as treatment options, either alone or in conjunction with conventional forms of therapy in patients with refractory symptoms.