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An '''IBS treatment''' is a medicine used to manage [[wikipedia:Irritable bowel syndrome|irritable bowel syndrome]], the functional gastrointestinal disorder characterised by chronic abdominal pain associated with altered bowel habit in the absence of structural pathology. The contemporary diagnostic framework, [[wikipedia:Rome process|Rome IV]] (2016), subdivides IBS by predominant bowel pattern: IBS-D (diarrhoea-predominant), IBS-C (constipation-predominant), IBS-M (mixed), and IBS-U (unsubtyped). The pharmacological strategy follows the subtype.

The clinical history of irritable bowel syndrome predates its name; the condition was described by Powell in 1820 as "mucous colitis" and by Cumming in 1849 as a condition in which "the bowels are at one time constipated, at another lax". The modern concept of IBS as a brain-gut-axis disorder, integrating visceral hypersensitivity, motility disturbance, low-grade mucosal immune activation, and a substantial psychological-stress contribution, has emerged from a hundred and fifty years of clinical observation and the past three decades of brain-imaging, visceral-physiology, and microbiome research.

The medicines for IBS divide into several categories. The smooth-muscle [[:Category:Antispasmodics|antispasmodics]] (dicyclomine, hyoscyamine, mebeverine in Europe, otilonium and pinaverium in Europe and South America) act on intestinal smooth muscle to reduce the post-prandial colonic spasm that drives a substantial fraction of IBS pain. [[wikipedia:Peppermint oil|Peppermint oil]] in enteric-coated capsules acts by similar smooth-muscle relaxation through L-type calcium channel blockade and has substantial controlled-trial evidence for both pain and bloating in IBS.

For IBS with diarrhoea (IBS-D), the symptomatic medicines are the gut-restricted opioid agonist [[wikipedia:Loperamide|loperamide]] (cross-listed under [[:Category:Antidiarrheals|antidiarrheals]] and [[:Category:Opioid_receptor_agonists|opioid receptor agonists]]; reduces stool frequency without systemic opioid effect), the bile-acid sequestrants ([[wikipedia:Cholestyramine|cholestyramine]], colesevelam) in patients with documented bile-acid diarrhoea (approximately a quarter of IBS-D cases on dedicated testing), and the 5-HT3 antagonist [[wikipedia:Alosetron|alosetron]] (Lotronex, GSK 2000, restricted to women with severe IBS-D after withdrawal in 2000 for ischaemic colitis and reintroduction 2002 under a restricted-distribution program). The mu-opioid agonist / delta-antagonist [[wikipedia:Eluxadoline|eluxadoline]] (Viberzi, Allergan 2015) is approved for IBS-D with the caveat of pancreatitis risk in patients without a gallbladder or with prior pancreatitis. The non-absorbable rifaximin (Salix/Bausch, IBS-D approval 2015 after the TARGET-3 trial) is a gut-restricted antibacterial that improves IBS-D symptoms by an incompletely understood mechanism, presumed to involve modification of the small-intestinal microbiome.<ref name="pimentel2011">Pimentel M, Lembo A, Chey WD, Zakko S, Ringel Y, Yu J, Mareya SM, Shaw AL, Bortey E, Forbes WP; TARGET Study Group. Rifaximin therapy for patients with irritable bowel syndrome without constipation. ''New England Journal of Medicine''. 2011 Jan 6;364(1):22-32. PMID 21208106.</ref>

For IBS with constipation (IBS-C), the symptomatic medicines include the standard osmotic laxatives (polyethylene glycol; cross-listed under [[:Category:Osmotic_laxatives|osmotic laxatives]]), the chloride channel activator [[wikipedia:Lubiprostone|lubiprostone]] (Amitiza, Sucampo 2008, opens the type-2 chloride channel in the intestinal epithelium and increases intestinal fluid secretion), the guanylate cyclase C agonists [[wikipedia:Linaclotide|linaclotide]] (Linzess, Ironwood/AbbVie 2012) and [[wikipedia:Plecanatide|plecanatide]] (Trulance, Salix 2017) that activate the same target as the heat-stable enterotoxin of ''E. coli'' (the natural ligand of the receptor on the intestinal epithelium), and the more recent sodium-hydrogen exchanger inhibitor tenapanor (Ibsrela, Ardelyx 2019) which reduces intestinal sodium absorption and so increases luminal water. The serotonin 5-HT4 agonist [[wikipedia:Tegaserod|tegaserod]] (Zelnorm, Novartis 2002, withdrawn 2007 for cardiovascular signal, reintroduced 2019 for women under age 65) and [[wikipedia:Prucalopride|prucalopride]] (Resotran/Motegrity, Shire/Takeda 2018 in U.S., earlier in Europe) act on intestinal motility through enteric-nervous-system serotonergic signaling and are alternatives.

The pain and psychiatric components of IBS are addressed by the low-dose tricyclic antidepressants ([[wikipedia:Amitriptyline|amitriptyline]], nortriptyline, imipramine, desipramine at 10-50 mg at bedtime, well below antidepressant doses) and the SNRIs (duloxetine, venlafaxine), used for central pain modulation and the visceral-hypersensitivity component. SSRIs are useful in IBS with psychiatric comorbidity but their efficacy on bowel symptoms alone is limited. The newer fixed-combination clidinium-chlordiazepoxide (an antimuscarinic plus benzodiazepine) is sometimes prescribed for refractory pain but its benzodiazepine component has restricted contemporary use.

The non-pharmacological foundation of IBS management, the [[wikipedia:Low-FODMAP diet|low-FODMAP diet]] developed by Sue Shepherd and colleagues at Monash University in the 2000s, is a substantial therapeutic intervention in its own right and is the only intervention with consistent superior outcomes to placebo across multiple trials. Cognitive-behavioural therapy, gut-directed hypnotherapy, and the recent dietary-and-cognitive-mechanism digital therapeutics (Mahana IBS, the prescription-app approved by the FDA in 2020) extend the non-pharmacological toolkit. The contemporary clinical approach combines a subtype-specific pharmacological strategy with low-FODMAP elimination and reintroduction, with cognitive-behavioural therapy or gut-directed hypnotherapy for patients with substantial psychological-stress contribution, and with the underlying recognition that IBS is a chronic disease in which symptom control rather than cure is the realistic goal.

== Classes indexed ==

By subtype and target:

* '''[[:Category:Antispasmodics|Antispasmodics]]''':
** Antimuscarinics (cross-indexed under [[:Category:Antimuscarinics|antimuscarinics]]): [[Dicyclomine|dicyclomine]], hyoscyamine
** Calcium channel blockers (smooth-muscle-selective, primarily European): mebeverine, otilonium, pinaverium
** Peppermint oil (enteric-coated): IBgard, Pepogest
* '''IBS-D specific''':
** [[wikipedia:Loperamide|Loperamide]] (gut-restricted opioid; OTC)
** [[wikipedia:Alosetron|Alosetron]] (5-HT3 antagonist; restricted distribution)
** [[wikipedia:Eluxadoline|Eluxadoline]] (mu-agonist / delta-antagonist; pancreatitis caution)
** [[wikipedia:Rifaximin|Rifaximin]] (gut-restricted antibacterial; cross-indexed under [[:Category:Antibacterials|antibacterials]])
** Bile-acid sequestrants: [[wikipedia:Cholestyramine|cholestyramine]], colesevelam (in bile-acid diarrhoea)
* '''IBS-C specific''':
** Osmotic laxatives (cross-indexed under [[:Category:Osmotic_laxatives|osmotic laxatives]]): polyethylene glycol, lactulose, magnesium-containing
** Chloride channel activator: [[wikipedia:Lubiprostone|lubiprostone]] (Amitiza)
** Guanylate cyclase C agonists: [[wikipedia:Linaclotide|linaclotide]] (Linzess), [[wikipedia:Plecanatide|plecanatide]] (Trulance)
** Sodium-hydrogen exchanger 3 inhibitor: tenapanor (Ibsrela)
** 5-HT4 agonists: [[wikipedia:Tegaserod|tegaserod]] (Zelnorm; restricted), [[wikipedia:Prucalopride|prucalopride]] (Motegrity)
* '''Pain and central modulation''':
** Tricyclic antidepressants (low-dose): [[wikipedia:Amitriptyline|amitriptyline]], nortriptyline, imipramine, desipramine
** SNRIs: [[wikipedia:Duloxetine|duloxetine]], venlafaxine
** SSRIs (for IBS with psychiatric comorbidity)
** Pregabalin (visceral hypersensitivity)
* '''Adjunctive''':
** Probiotics (selected strains with positive trial data, including ''Bifidobacterium infantis'' 35624; evidence variable)
** Soluble fibre (psyllium for IBS-C; insoluble fibre worsens symptoms)

== Notes on scope ==

The boundary of this category is "medicine used in the management of irritable bowel syndrome." The medicines used in [[wikipedia:Inflammatory bowel disease|inflammatory bowel disease]] are listed under [[:Category:IBD_medications|IBD medications]] separately, despite the symptomatic overlap. The medicines used in [[wikipedia:Diverticular disease|diverticular disease]] (antibacterials for diverticulitis; fibre for diverticulosis prevention) are not in this category. The medicines used in [[wikipedia:Chronic idiopathic constipation|chronic idiopathic constipation]] (the same lubiprostone, linaclotide, plecanatide, prucalopride, tenapanor, also approved in non-IBS chronic constipation) are cross-listed but their indication-specific approvals differ. The non-pharmacological interventions (low-FODMAP diet, cognitive-behavioural therapy, gut-directed hypnotherapy, the digital therapeutics) are foundational to IBS management but not medicines and are mentioned only for clinical-decision context.

== About these pages ==

This category page is an encyclopedia article about its subject. The actual index of medicines belonging to the category is generated automatically by the wiki engine, from category-membership declarations on the individual medicine pages, and appears at the foot of the page below the references.

== References ==

<references/>

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Category:IBS treatments - Revision history

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