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]
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 | |
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 | Â | Diarrhea more common with active therapy | |
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 | |
5-HT3 receptor antagonists | Diarrhea | High | Retard colonic transit and reduce visceral pain | Serious adverse events with alosetron included ischemic colitis and severe constipation | |
Rifaximin | Diarrhea | Moderate | Nonabsorbable antibiotic | Nausea more common with active therapy | |
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 | |
Antidepressants | Pain | Moderate | Psychological, antinociceptive, slow (TCA) or fast (SSRI) transit effects | dry mouth and drowsiness | |
Antispasmodic drugs | Pain | Low | Inhibition of muscarinic Ach receptors or block calcium ion channels, GI smooth muscle | dry mouth, dizziness, and blurred vision |