Management of irritable bowel syndrome

Management of patients with irritable bowel syndrome (IBS) is based on the positive diagnosis of the symptom complex, limited exclusion of underlying organic disease and institution of a therapeutic trial. As a general approach, physician should establish an effective therapeutic relationship by providing clearly understood explanation to patients of the causes and implications of their symptoms, supported by reassurance and appropriate therapy. Treatment of IBS needs to be individualized, focusing on patients' predominant symptoms. In diarrhea- predominant IBS, loperamide and some antispasmodic agents are efficacious. In constipation-predominant IBS, fiber and bulk laxatives are used empirically, but their efficacy is variable and may aggravate bloating. The 5-HT4 receptor agonist, tegaserod is efficacious in female patients with IBS and constipation. In patients with IBS and abdominal pain, antispasmodics and antidepressants can be used but there is weak evidence of potential benefit. New novel pharmacological agents are being carefully appraised as potential drugs for the future.