Japikse 1

Logan Japikse

Prof. Waggoner

ENG 1201

21 March 2021

What treatment for IBS yields the best results?

IBS is one of the most common gastrointestinal disorders across the world. It’s

prevalence might even be understated because of its difficulty to diagnose. IBS affects each

individual differently and this variety in symptoms makes both treatment and detections a

complex task. Many differing ideas have been proposed for treatment including but not limited

to diet, exercise, and prescription medication ranging from anticholinergics to antidepressants.

When comparing treatment options does one or a few of these stand out above the rest?

IBS manifests in two distinct ways. Patients can either have IBS-C or IBS-D, IBS-C

being mainly constipation oriented and IBS-D being mainly diarrhea oriented. The two different

forms have separate treatments, but they are both treated for symptoms and not for the ailment as

a whole. As Emanon Quigley, a gastroenterologist put it, “It’s not a definitive disease. It’s a

collection of symptoms… IBS probably encompasses a number of entities.” (qtd. in Adams). It’s

this lack of knowledge on the subject that makes treatment for IBS difficult. While a patient

suffering from IBS-C might be recommended stool softeners, IBS-D prominent patients would

need medication to do the opposite. Most patients with IBS report bloating, cramping, pain in the

stomach, and a feeling of fullness, but other symptoms can vary widely from patient to patient.

Each patient’s affliction is unique and as such needs to be treated with personalized care.

For most chronic IBS patients, prescription medications are used to help treat symptoms.

The most common of these are antispasmodics and antidepressants. Antispasmodics help to
 Japikse 2

decrease the tension caused by contractions in the intestines. This helps alleviate pain and

bloating as reported by Hadley and Gaarder in their research on the subject. However, there is

some contention over the use of antispasmodics. William D. Chey states that, “it doesn't make

sense any sense to me to use anticholinergics for chronic abdominal pain. I can't envision a

reason why that would work” (qtd. in HCPLive). While he does see a usefulness in certain

scenarios, the effect that the antispasmodics, also called anticholinergics in this setting because

of their application, is not practical for most patients suffering only from abdominal pain.

Antidepressants, referred to as neuromodulators in this application, have a similar anticholinergic

effect on the body. Both of these types of medication are much more effective in treating IBS-D

patients and the data is not in strong support of helping IBS-C patients (HCPLive 02:43-04:03).

Over the counter remedies can be less intrusive than full prescriptions and help to

increase a patient’s quality of life. One such remedy is probiotics. As Bahra Hamarashid

explained, “Probiotics are live strains of strictly selected microorganisms that confer a health

benefit on the host when administered in adequate amounts” (44). These can be used to

reestablish a healthy microbiome in the intestines. However, probiotics can be hit or miss for

some patients. Guidelines on quality are not strictly set and that leads to widely different

effectiveness and quality across brands (Adams). Other over the counter medications can have

benefits, however no one of these is enough to fully encompass all the symptoms. Certain

medications, like immodium, are effective in reducing the speed at which the bowel moves, but

patients are still left with the pain, bloating, and other adverse effects of the disorder (HCPLive

01:06-01:44). For short term symptom relief, patients may turn to using over the counter

medications, but their effectiveness for long term and all around relief is questionable.
 Japikse 3

Because of the drastic change in functionality for a patient’s digestive processes,

changing the way they live their life can have a definite impact on the condition. The most

noticeable difference is through an altered diet. Patients affected with IBS can be sensitive to

certain foods, “Generally, recommendations are based on regular eating habits and limit the

consumption of possible dietary causes such as alcohol, caffeine, spicy foods, and fat”

(Hamarashid, 40). An approach to countering the effects of these triggering foods is the low-

FODMAP diet. The goal of the low-FODMAP diet is to decrease the amount of indigestible

foods. Similar to other treatments, each patient has a different set of foods that can cause a flare

up. Getting positive results from a FODMAP diet can be a long and arduous process. A patient

has to start with removing all FODMAP foods and adding them back into their diet one by one

(Adams). Another lifestyle modification that can benefit patients is exercise. However the actual

effectiveness of these changes are debated. As Eamonn Quigley stated, “Exercise and diet

therapies received weak recommendations due to the lack of high-quality evidence,” however he

did not discredit the ideas all together; “It is clear that exercise is better than a sedentary lifestyle

in terms of general health, and there is some encouraging evidence to suggest that exercise might

help patients with IBS” (666). Although the data might not be enough to have a definitive answer

on their usefulness, some patients might find these methods worth giving a try.

A new advancement in treatment for IBS follows the connection between the gut and the

brain. New evidence suggests that the gut has a more complex arrangement of neurons than

previously thought. This allows it to function as its own small operating system. A lot more than

just food can have an effect on how the gut operates; “thoughts, emotions, and behaviours are

proposed to be bi-directionally related to gut physiology and symptom manifestations in IBS”

(Hamarashid, 44). In this way, psychotherapy has been shown to improve patient’s conditions.
 Japikse 4

Using methods like cognitive behavioral therapy to reduce stress in patients lives can greatly

decrease the occurrence of symptoms (Hadley, 7).

When approaching treatment for IBS, the chronic nature and lack of understanding on the

subject can be daunting. No one treatment clearly triumphs over the others. The most effective

way to treat IBS might consist of a trial and error method of each of the different methods. Every

patient has an individual experience that only they can determine what effectively treats their

needs. One combination or variance of methods previously mentioned could provide benefits for

certain patients, while granting little to no benefits for others. The only way to effectively treat

the condition is to evaluate each patient's symptoms and determine which type of IBS they are

most affected by.

 Japikse 5

Works Cited

Adams, Jill U. “Understanding and dealing with irritable bowel syndrome.” The

Washington Post, 27 May 2019, pp. 3.

Hadley, Susan K., and Stephen M. Gaarder. “Treatment of Irritable Bowel Syndrome.”

American Family Physician, 15 Dec. 2005,

https://www.aafp.org/afp/2005/1215/p2501.html

Hamarashid, Bahra R. et al. “Irritable Bowel Syndrome (IBS): A Review.” Journal of

Advanced Laboratory Research in Biology, vol. 11, no. 3, July 2020, pp. 36-52.

Directory of Open Access Journals.

HCPLive, “Treating IBS: Antispasmodics and Neuromodulators.” Youtube, 2 July 2019,

https://www.youtube.com/watch?v=Xn-yYFizFYc

Quigley, Eamonn M. “Highlights of the Updated Evidence-Based IBS Treatment

Monograph...Quigley EMM.” Gastroenterology & Hepatology, vol.14 no. 11, Nov. 2018,

pp. 665-667. CINAHL Complete.