Traditionally, physicians have had a great deal of difficulty coming up with adequate medical treatments for IBS. Medications used to treat the disorder have generally been aimed at treating single symptoms (such as pain or diarrhea) of this complex syndrome, and have often proven limited in effectiveness even on those symptoms. Among medications with most consistent effectiveness on IBS symptoms (Camilleri, 1999) are Loperamide and antidepressants (the latter help not only symptoms of depression in depressed IBS patients, but also improve pain and diarrhea in some individuals). Overall, the response of the syndrome to medication interventions has been inconsistent and disappointing, leaving a substantial proportion of patients with little or no lasting relief. Dr. Grant Thompson, one of the world's authorities on IBS, concluded in his review of pharmacologic management of IBS: “The sheer number and variety of drugs sold …for IBS treatment are testimony to their collective uselessness" (Thompson, 1994).

This pessimistic picture has seemed like it might finally be changing to some degree as new classes of medications have emerged that seem to be able to address this disorder. However, the drugs introduced so far have faced significant difficulties.

The first among the drugs, Lotronex, was introduced with much fanfare in the Fall of 1999, but was was pulled voluntarily off the market less than a year later by Glaxo-Wellcome, due to concerns about several deaths which may have been attributable to the effects of this medication (see link to CNN story below). Many regretted the loss of this first medication specifically designed for IBS treatment. In a remarkable and unusual reversal (see link below), Lotronex has now been reapproved for use by the FDA, and reintroduced on the market with extra precautions to address the risks previously identified.

The next medication to arrive on the market for IBS was Tegaserod, produced by Novartis. It has been on the market for a few years in the U.S. It is marketed under the name Zelnorm, and is specifically intended for use to relieve constipation-type IBS problems. Because of the significant restrictions on Lotronex, Zelnorm has in practice been the main IBS-specific medication for the last few years. However, in March of 2007, Novartis stopped sales and marketing of Tegaserod temporarily due to concerns about increase in cardiovascular problems (angina, heart attacks and stroke) in data on patients using the drug, even though the incidence of these adverse events is very low. This medication remains off the market for general use for IBS, but restricted use is permitted by the FDA for patients who meet certain qualifications. See FDA information here.

The recent availability of Lotronex and Zelnorm has heralded a whole new era in IBS treatment: For the first time ever, IBS-specific medications are available to physicians. However, although promising, these drugs have proven to be far from being the final answer in IBS treatment. Both are only effective in women, have relatively small impact on symptoms in many patients, and only about half of patients respond in a beneficial way to these treatments. And now, both of them have concerns about adverse health effects attached to them, causing them to be offered only with substantial restrictions).

So what else is on the horizon in terms of pharmaceutical help for IBS? The FDA is now considering Lubiprostone (Amitiza), which is already approved for treating chronic constipation, for approval for treatment of constipation-predominant IBS also.

Apart from medications, common methods used to attempt to control IBS include changes in diet, various alternative medicine methods, probiotics, and psychological approaches.

The most common symptom-inducing foods for IBS patients are spicy foods and food with high fat content. Often patients can get at least temporary relief by reducing the amount of such foods in their diet. However, such adjustments in diet rarely lead to lasting improvement in the condition. Increasing fiber in the diet, with fiber supplements of at least 12 g per day (Camilleri, 1999) helps many patients with constipation- predominent IBS.

Many IBS sufferers who have not had good luck with regular medical management of their symptoms try various home remedies and alternative medicine medicine regimens. Unfortunately, they often fall prey to unwarranted claims for symptom relief from anything from herbal and homeopathic medications to colon cleansing, spending a great deal of money and may possibly suffer harm from the effects of such therapies. Among alternatives to medication, only psychological treatments and peppermint oil have the research base to back up their use in IBS.

Among psychological treatments tested for the disorder, hypnosis treatment has shown the highest success rate in replicated studies, with studies commonly showing an astounding 80-95% of patients improving and improvement lasting for at least a couple of years. The other effective psychological treatment for IBS is cognitive therapy. Brief psychodynamic psychotherapy has also shown some success, but less research has been done on that form of IBS treatment to date than on hypnosis.


Further online information on this topic:

FDA Permits Restricted Use of Zelnorm for Qualifying Patients (July 2007)

Novartis Suspends US Marketing and Sales of Zelnorm(R) in Response to Request from FDA (March 2007)

FDA health advisory on Zelnorm (March 2007)

Lotronex returns to the market (USA Today story)

Zelnorm shows promise for constipation-type IBS in women

Lotronex pulled off the market: CNN story

Selected literature references on this topic:

Camilleri M. 1999. Review article: clinical evidence to support current therapies of irritable bowel syndrome. Aliment Pharmacol Ther, May, 13 Suppl 2:, 48-53.

Koch, T.R. 1998. Peppermint oil and irritable bowel syndrome. Am J Gastroenterol 93(11):2304–2305.

Liu, J.H., G.H. Chen, H.Z. Yeh, C.K. Huang, S.K. Poon. 1997. Enteric-coated peppermint-oil capsules in the treatment of irritable bowel syndrome: a prospective, randomized trial. J Gastroenterol 32(6):765–768.

Nash, P., S.R. Gould, D.E. Bernardo. 1986. Peppermint oil does not relieve the pain of irritable bowel syndrome. Br J Clin Pract 40(7):292–293.

Pittler, M.H. and E. Ernst. 1998. Peppermint oil for irritable bowel syndrome: a critical review and meta-analysis. Am J Gastroenterol 93(7): 1131–1135.

Read, NW. Harnessing the patient's powers of recovery: the role of the psychotherapies in the irritable bowel syndrome. Baillieres Best Pract Res Clin Gastroenterol, 1999 Oct, 13:3, 473-87

Thompson, G.W. (1994). Canadian Family Physician, 40, p. 314.

Whorwell PJ; Prior A; Faragher EB. Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome.The Lancet 1984, 2: 1232-4

Whorwell PJ; Prior A; Colgan SM. Hypnotherapy in severe irritable bowel syndrome: further experience. Gut, 1987 Apr, 28:4, 423-5.