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Table 1 Summary of treatments for IBS-related symptoms [98,99,100,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115]

From: Irritable bowel syndrome and microbiome; Switching from conventional diagnosis and therapies to personalized interventions

Therapy type/class IBS-related symptoms Data Quality Mechanism of action Adverse events References
5-HT4 receptor agonists Constipation High Stimulate colonic
motility and transit
Diarrhea, cramping, and cardiovascular side effects [97, 98]
Tenapanor Constipation Moderate NHE3 inhibitor, stimulates sodium + ,
water secretion
Diarrhea more common with active therapy [99]
IBAT inhibitor Constipation Moderate Increases colonic bile acid levels to induce
secretion and motility
Diarrhea, cramping [100]
Linaclotide Constipation High Guanylate cyclase C activator, stimulate
chlorine − and water secretion via CFTR;
visceral analgesia
Diarrhea more common with active therapy [97]
Plecanatide Constipation High   Diarrhea more common with active therapy [101, 102]
PEG 3350 Constipation Moderate Osmotic secretion Diarrhea and abdominal pain [103]
Lubiprostone Constipation Moderate Chloride channel activation and with
CFTR stimulate chlorine − secretion;
inhibitor of NHE3
Nausea more common with active therapy [104]
Bile acid sequestrants Diarrhea Low Bind intraluminal bile acids Limited data [105, 106]
5-HT3 receptor antagonists Diarrhea High Retard colonic transit and reduce visceral pain Serious adverse events with alosetron included
ischemic colitis and severe constipation
[107, 108]
Rifaximin Diarrhea Moderate Nonabsorbable antibiotic Nausea more common with active therapy [107, 109]
Eluxadoline Diarrhea High κ-Opioid and μ-opioid receptor agonists and
δ-opioid receptor antagonist
Serious adverse events included acute pancreatitis and sphincter of Oddi spasm [107]
Peppermint oil Pain Moderate Blocks L-type calcium ion channels on muscle, activate TRPM8 receptors on nociceptive afferents No increase in adverse events in randomized clinical trials [110, 111]
Antidepressants Pain Moderate Psychological, antinociceptive, slow
(TCA) or fast (SSRI) transit effects
dry mouth and drowsiness [110, 112]
Antispasmodic drugs Pain Low Inhibition of muscarinic Ach receptors or block
calcium ion channels, GI smooth muscle
dry mouth, dizziness, and blurred vision [113, 114]