Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:44

Irritable Bowel Syndrome 873

■Reassure the patient regarding the chronic and benign nature of the

syndrome

General Measures

■Dietary modification; exclusion of foods that increase flatulence

■Increase dietary fiber

specific therapy

Pharmacological Therapy

■Medications only an adjunct to treatment

■Pharmacologic therapy depends on patient’s symptoms

■Anticholinergic agents

➣May be beneficial in patients with post-prandial abdominal pain,

gas, bloating and fecal urgency

➣Commonly used:

Dicyclomine

Hyoscyamine

Hyoscyamine

■Anti-diarrheal agents

➣Beneficial in diarrhea-predominant IBS

➣Should be used on an as needed basis

➣Loperamide and cholestyramine have been found to be helpful

■Antidepressants

➣May be beneficial in patients with neuropathic-type pain

➣Improvement in pain may occur at lower doses than those

needed for the treatment of depression

➣Tricyclic antidepressants (amitriptyline and imipramine) and

selective serotonin re-uptake inhibitors can be used (paroxetine,

fluoxetine, or sertraline)

■5-hydroxytryptamine agonists

➣May increase colonic motility and improve constipation

➣First drug of its class undergoing evaluation and may be approved

for use in the near future

■Anxiolytics

➣Limited usefulness due to risk of habituation and withdrawal

➣May be used in the short-term to reduce anxiety if it is an aggra-

vating factor

Psychosocial therapies

■Cognitive behavioral treatment, hypnosis, psychotherapy, relaxation

techniques can help reduce anxiety, improve health promoting

behavior and pain tolerance