Traditionally, physicians have had a great deal of difficulty coming up with adequate medical treatments for IBS. Until 1999, there were no medications specifically approved for IBS treatment. A wide variety of drugs was used to treat individual symptoms been aimed at treating single symptoms (such as pain or diarrhea) of this complex syndrome, and often proved to have limited effectiveness even on those symptoms. Overall, the response of the syndrome to medication interventions has been inconsistent and disappointing, leaving a substantial proportion of patients with little or no lasting relief.

However, the prospects of effective treatment with medication have been improving in the past few years, as new classes of medications have emerged that seem to be able to address this disorder better. The past decade has seen the arrival of the first three medications approved specifically for IBS treatment, and more are likely to become available in the next few years. However, the beneficial impact of these IBS-approved drugs is limited so far by the fact that they are only approved for use with a subset of IBS patients (restricted by gender and bowel symptom subtype), and that two of them are also severely restricted due to health concerns.

The newest IBS medication, and the one with the widest general applicability in IBS, is Lubiprostone (Amitiza), which was approved by the FDA for use in IBS in April of 2008. It is only approved for treating female IBS patients with constipation-predominant IBS, but for those patients, it is likely to be a welcome and valuable treatment option. See FDA announcement about the approval here.

The other two drugs introduced so far for IBS treatment have faced significant difficulties due to health concerns byt the FDA, and are only available with restrictions that greatly limit their practical use for this disorder.

The first among the IBS-approved drugs, Lotronex, was introduced with much fanfare in the Fall of 1999, but was was pulled voluntarily off the market less than a year later by Glaxo-Wellcome, due to concerns about several deaths which may have been attributable to the effects of this medication. Many regretted the loss of this first medication specifically designed for IBS treatment. In a remarkable and unusual reversal (see link below), Lotronex has now been reapproved for use by the FDA, and reintroduced on the market with extra precautions to address the risks previously identified.

The second medication to arrive on the market for IBS was Tegaserod, produced by Novartis. It has been on the market for a few years in the U.S. It is marketed under the name Zelnorm, and is specifically intended for use to relieve constipation-type IBS problems. Because of the significant restrictions on Lotronex, Zelnorm has in practice been the main IBS-specific medication for the last few years. However, in March of 2007, Novartis stopped sales and marketing of Tegaserod temporarily due to concerns about increase in cardiovascular problems (angina, heart attacks and stroke) in data on patients using the drug, even though the incidence of these adverse events is very low. This medication remains off the market for general use for IBS, but restricted use is permitted by the FDA for patients who meet certain qualifications. See FDA information here.

Among other medications than those with specific approval for IBS, the ones with the most consistent effectiveness on IBS symptoms (Camilleri, 1999) are perhaps Loperamide (Imodium) and antidepressants (the latter help not only symptoms of depression in depressed IBS patients, but also seem improve pain and diarrhea in some individuals who do not have significant depression).

Apart from medications, common methods used to attempt to control IBS include changes in diet, various alternative medicine methods, probiotics, and psychological approaches.

The most common symptom-inducing foods for IBS patients are spicy foods and food with high fat content. Often patients can get at least temporary relief by reducing the amount of such foods in their diet. However, such adjustments in diet rarely lead to lasting improvement in the condition. Increasing fiber in the diet, with fiber supplements of at least 12 g per day (Camilleri, 1999) helps many patients with constipation- predominent IBS.

Many IBS sufferers who have not had good luck with regular medical management of their symptoms try various home remedies and alternative medicine medicine regimens. Unfortunately, they often fall prey to unwarranted claims for symptom relief from anything from herbal and homeopathic medications to colon cleansing, spending a great deal of money and may possibly suffer harm from the effects of such therapies. Among alternatives to medication, only psychological treatments have sufficient research base to back up their use in IBS, although some other options like probiotics and enterically coated peppermint oil capsules also show promise.

Among psychological treatments tested for the disorder, hypnosis treatment has shown the highest success rate in replicated studies, with studies commonly showing an astounding 80% or more of the treated patients improving and improvement commonly lasting for at least a couple of years. The other effective psychological treatment for IBS is cognitive (or cognitive-behavioral) therapy. Brief psychodynamic psychotherapy has also shown some success, but less research has been done on that form of IBS treatment to date than on hypnosis.


Further online information on this topic:

FDA Approves Amitiza for IBS-C (April 2008)

FDA Permits Restricted Use of Zelnorm for Qualifying Patients (July 2007)

Novartis Suspends US Marketing and Sales of Zelnorm(R) in Response to Request from FDA (March 2007)

FDA health advisory on Zelnorm (March 2007)

Lotronex returns to the market (USA Today story)

Zelnorm shows promise for constipation-type IBS in women

Lotronex pulled off the market: CNN story

WMD: Good gut bugs help IBS