01 Aug There are four major goals when treating IBS patie
There are four major goals when treating IBS patients: (1) improve the individualized symptoms of IBS (i.e. abdominal pain and discomfort, bloating, and diarrhea); (2) improve the universal symptoms of IBS (3) prevent complications of IBS which include preventable surgery, risky diagnostic procedures, and adverse medication side effects from polypharmacy; and (4) reduce the impact of IBS on this patient by improving quality of life and decreasing health care costs (Lacy, et al., 2016).IBS is categorized as a diarrhea predominant (IBS-D), constipation-predominant (IBS-C), mixed-pattern (IBS-M), or unsubtyped (IBS-U) phenotype (Vanuytsel, Tack, & Boeckxstaens, 2014). Treatment will be addressed to treat these types of Irritable bowel syndrome, depending on the predominant stool pattern.Pharmacotherapy goals are relieving abdominal pain and improving bowel function. For patients with predominant diarrhea, antidiarrheal agents (mainly loperamide) are helpful. On the other hand, in patients with constipation fiber supplements may softening stools.Even non pharmacological treatment including lifestyle modifications, behavioral, and herbal therapies, have been used in the management of IBS, pharmacological treatment depends on the symptoms of the patient. In this specific case, patient has diarrhea, with cramping, accompanied by nausea and vomiting. In this case, it seems that there is a diarrhea predominance IBS. First line of treatment includes antidiarrheal and antispasmodics.Loperamide (2mg tab) is an antidiarrheal used in patients with IBS-D. The starting dose in adults is 4mg, then 2mg after each loose stool, not exceeding 8mg/day for OTC use or 16mg /day for prescription use. This medication improves stools consistency, reduces stool frequency, and increases external anal sphincter tone, but it doesn’t clear IBS symptoms (Woo, & Robinson, 2016).Antispasmodics are used in IBS treatment for reducing pain and bloating because their anticholinergic effects, it leads to smooth muscle relaxation and the pain decreases but they have undesirable adverse effects related to anticholinergic effects (Annahazi, Roka, Rosztoczy, & Wittmann, 2014). However, some patients improve with antispasmodic drugs, particularly those whose symptoms are induced by meals and those who complain of tenesmus. When used for meal-induced symptoms, anticholinergics should be prescribed 3060 minutes before meals so that peak serum levels of the drug coincide with peak symptoms. Dicyclomine, hyoscyamine, and Peppermint oil have been demonstrated more useful than placebo.Tricyclic antidepressants (TCAs, like amytriptiline or desipramine, 10-15 mg/day) and selective serotonin reuptake inhibitors (SSRI) affect gastrointestinal motility through anticholinergic and serotonergic mechanisms and might therefore influence bowel habit disturbances in IBS. These medications constitute the second line of treatment in IBS.5HT3 receptors antagonist, like Alosentron, should be used if the previous treatments failed and in the severe disease diarrhea predominantly in women (Higgins, Davis, & Laine, 2004). Inhibition of 5HT3 receptors may reduce nausea, bloating and pain. The dosage is 1 mg once or twice daily.ReferencesAnnahazi, A., Roka, R., Rosztoczy, A. & Wittmann, T. (2014). Role of antispasmodics in the treatment of irritable bowel syndrome. World J. Gastroenterol. 20; 60316043.Chapman, R. W., Stanghellini, V., Geraint, M. & Halphen, M. (2013). Randomized clinical trial: macrogol/PEG 3350 plus electrolytes for treatment of patients with constipation associated with irritable bowel syndrome. Am. J. Gastroenterol; 108: 15081515.Higgins P. D. R., Davis K.J., & Laine L. (2004). The epidemiology of ischemic colitis. Aliment Pharmacol Ther; 19:729738.Lacy, B. E. et al. (2016). Bowel disorders. Gastroenterology; 150: 13931407.Vanuytsel, T., Tack, J.F., & Boeckxstaens, G.E. (2014). Treatment of abdominal pain in irritable bowel syndrome. J Gastroenterol; 49: 1193- 1205.Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics for advanced practice nurse prescribers. Philadelphia: F.A. Davis Company.
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