Psychological approaches to managing irritable bowel syndrome are shown effective
Hayee B, IForgacs I. Psychological approach to managing irritable bowel syndrome. BMJ. 2007;334:1105-1109.
Irritable bowel syndrome results from a variety of biological and psychosocial factors. If psychological factors seem important, these should be addressed. Successful strategies include tricyclic antidepressants and some selective serotonin reuptake inhibitors which can be of value in improving symptoms. Cognitive behavior therapy has a strong evidence base for its effectiveness. Gut directed hypnotherapy is an effective treatment especially for patients more severely affected by the condition.
Diet and Nutrition
Zar S, Mincher L, Benson MJ, et al. "Food-specific IgG4 antibody-guided exlucsion diet improves symptoms and rectal compliance in irritable bowel syndrome." Scandinavian Journal of Gastroenterology. 40(7):800-7, 2005.
Dietary modification may improve IBS symptoms. IgG4 antibodies to common food antigens are elevated in IBS with IgG4 antibodies to milk, eggs, wheat, beef, pork and lamb being the most common. This study evaluated the effect of an exclusion diet based on IgG4 titres on IBS symptoms. Twenty-five IBS patients who went on an exclusion diet showed significant improvement in IBS symptoms, including pain severity and frequency, bloating severity, satisfaction with bowel habits and effect of IBS on life in general at 3 months. Symptom improvement was maintained at six months.
Research review does not show benefit of drug therapy for IBS
Quartero AO, Meineche-Schmidt V, Muris J, et al. "Bulking agents, antispasmodic and antidepressant medication for the treatment of irritable bowel syndrome." Cochrane Database of Systematic Reviews. (2): CD003460, 2005.
The primary objective of this large review was to evaluate the effectiveness of bulking agents, antispasmodics and antidepressants for the treatment of IBS. Data from 40 studies were analyzed. These included 11 reports on bulking agents, 6 on antidepressants, and 24 on spasmolytics. Results show that the evidence for the effectiveness of drug therapies for IBS is weak. There is some evidence of the benefit of antispasmodic drugs for abdominal pain and overall improvement of symptoms. There is no clear evidence of benefit for antidepressants or bulking agents, although bulking agents may improve constipation in individual patients.