New treatments for IBS

Abstract

IBS is a common disorder that affects approximately 5–20% of the populations of Western countries; the main symptoms are abdominal pain and erratic, altered bowel habits, often accompanied by bloating. Despite an array of available pharmacological and nonpharmacological treatments aimed at a wide variety of gastrointestinal and brain targets, many patients do not report adequate symptom relief. The effect of IBS on an individual can be enormous, and the societal and financial costs overall are high, which is indicative of an unmet need for effective IBS treatments. Intense research efforts are ongoing that range from the development of new molecules for pharmacological therapies to testing the utility of internet technology to facilitate widespread delivery of efficacious behavioural therapy. This Review discusses the latest treatments for IBS, including novel nonpharmacological and pharmacological approaches. We have included estimates of the number needed to treat and the number needed to harm for selected treatments. Emerging and potential future treatments are included, with the data supporting an optimistic view about the future of IBS therapeutics. The ability to optimize therapy by individualizing management whilst also avoiding harm remains the key to achieving the best possible outcomes with currently available therapeutics.

Key Points

  • IBS is common and affects the quality of life of patients with this syndrome

  • Current therapies focus on symptom relief not cure

  • The patient–physician relationship and education about the condition remain key to optimal management of IBS

  • Emerging nonpharmacological therapies include a low FODMAP diet and exercise

  • Current drug therapies used as single therapy do not provide adequate symptom relief for many patients with IBS

  • New pharmacological therapies are emerging, including drugs that act locally in the intestinal lumen, but the cost-effectiveness of these therapies is largely undetermined

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Figure 1: Therapies for IBS.

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M. Halland researched data for the article, contributed to discussion of the article content, wrote the article and reviewed/edited the manuscript before submission. N. J. Talley contributed to discussion of the article content and reviewed/edited the manuscript before submission.

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Correspondence to Nicholas J. Talley.

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Competing interests

N. J. Talley has consulted for ARYx, Astellenas Pharma, Boehringer Ingelheim, Care Capital, ConCERT Pharma, Doyen, Edusa Pharmaceuticals, Falk, Forest, Ironwood Pharmaceuticals, Janssen, Johnson & Johnson, Meritage Pharma, NicOx, Novartis, Pfizer, Proctor & Gamble, Prometheus, Salix Pharmaceuticals, Sanofi–Aventis, Shire, Theravance, Tranzyme, UpToDate, XenoPort and Zeria, received speakers fees from Abbott, Accreddit Ed, AstraZeneca, Focus Medical, Ironwood Pharmaceuticals and Salix Pharmaceuticals and has patents with Prometheus and separately for biomarkers, and has received research support from Falk, Forest, Janssen and Takeda. M. Halland declares no competing interests.

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Halland, M., Talley, N. New treatments for IBS. Nat Rev Gastroenterol Hepatol 10, 13–23 (2013). https://doi.org/10.1038/nrgastro.2012.207

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