January 11th, 2010

How Do You Spell Relief for Irritable Bowel Syndrome?

I admit it. I’m frustrated. I do not know how to manage a substantial portion of my IBS patients because so few of them get relief from traditional therapies (bulking agents, antidiarrheals, tricyclic antidepressants, etc.).

Recently, I noticed that many of my colleagues are using Align probiotics, Iberogast herbal supplements, and other alternative/complementary therapies for their IBS patients. So, I diligently re-reviewed the literature on these treatments but came away more confused than ever; the studies are varied and usually small, the endpoints are unclear, and the follow-ups are short. Yet, my colleagues and their patients seem a whole lot more satisfied with the outcomes than I am.

Do you use alternative treatments for IBS? If so, what do you use, and what responses are you seeing?

22 Responses to “How Do You Spell Relief for Irritable Bowel Syndrome?”

  1. facundo says:

    I have amazing results in my practice with exclusion diet ( specially in patients with headache,edemas and fatigue.

  2. Adam says:

    Share MBF’s experience here. I tell patients honestly the equivocal to unprofen benefits of all the therapies and steer them toward the least toxic, least expensive-a summary which applies to probiotics. In this way, I don’t feel I’m misleading pt’s, myself, or others into any fale hope with IBS therapies.

  3. Marc K. Binder says:

    All therapies seem to have marginal benefit – adding hypnosis and peppermint oil to the list(TCAs,probiotics, xifaxin, etc). I think the best therapy is the most difficult to give – TIME – regularly scheduled followup visits using CBT(cognitive behavioral therapy)in these folks who frequently catastrophize and somatosize. Reframing perceptions and teaching resiliency are the necessary skills so that those severe folks immobilized with their sxs can begin to live with them and accept and start to function despite their problems-rather than the prior agenda of expecting something that’s terribly wrong can be “fixed.” Ongoing visits, rapport, and trust – that’s the ticket!

  4. Kate Killebrew, MD says:

    Just make sure that you’ve ruled out other treatable etiologies before you make the diagnsosis IBS!

    My brother-in-law, not a complainer, who had a type A dissection last year treated at Mass General, came down with abdominal pain this fall. His crazy family and primary felt it was IBS and treated him with ?’senna”? with sowho scheduled a CT abdomen along with his follow-up CT chest–and diagnosed pancreatic cancer. He lost a few months; it might not have made a difference, you say, but maybe it did. We’ll never know. This is the second delayed diagnosis of this cancer in my circle within a year, the other back pain, carried for months before the inevitable diagnosis. We’ll never cure it if we don’t diagnose it in time.

  5. John GILBERT says:

    I see quite a lot of IBS in General Practice and use the same range of therapies as you. In addition I have noticed that the majority of IBS patients also have food sensitivities, sometimes completely idiosyncratic. So I spend a little time with them discussing how to go about identifying the culprit(s). I don’t know if it’s the time spent, or having something to do, or feeling in control of their own destiny but it often seems to work.

  6. Kyle Lewis says:

    I’m only a medical student right now, but from the view of a patient with IBS, I’d have to agree with many of the statements made above. I had a great GI doc who spent a significant amount of time with me, validating that there was an issue and reiterating that I wasn’t imagining it. She also recommended that I keep a food/symptom diary, because as was mentioned by Mr. Gilbert above, there seems to be food sensitivity issues for me as well as other IBS patients I’ve spoken to. In my case it was mainly due to stress, but in retrospect, having an active role in my care helped a great deal.



  7. kate says:

    I am a patient,(and student) but thought my input might help someone else. My physician at Mass General in Boston suggested Miralax (or the generic alternative) daily for a long-term struggle with IBS (constipation symptoms). I’m not sure there is a downside, but the effect was immediate; only side effect is flatulence.

  8. Helen Orland says:

    Nicely written piece. Keep up the good job you’re doing.

  9. Leanne says:

    I have found as a pediatrician that some of these patients end up having organic disorders, including celiac disease. Knowing that this illness can show up later in life reinforces what Kate said about ensuring something else is not the cause of the symptoms. I have seen dramatic improvements in patients once proper diagnoses have been made. We’re probably all doing this anyway, but I was surprised to find the number of patients with celiac disease that had no other associated illnesses. Thanks for all your input!

  10. There could be a variety of reasons including environment and food habits. Thats why some alternative therapies and traditional treatements work well and are truste by many.

  11. Paul says:

    there’s some evidence to suggest that hypnosis can help. I’d also look at specific diets that may be able to determine whether a type of food is the cause. I’ve used hypnosis a fair bit and seem to get a high success rate. The patient must remove the ‘stressors’ from this environments for it to be effective long term.

  12. Steve says:

    Hypnosis has been effective for many of my clients. Would like to research some clinical trials on this

  13. Patricio Torres-Lisboa,MD says:

    Hello gentlemen,I stumbled on your dialogue and could not help butting in.I am an old shrink on sabattical abroad.
    I hear from patients (and friends)with DX´d IBS that a ritual of fixing their own Kefir with flaxseed meal and some Inuline takes care of most of their ailments without making them disappear. I do it myself without having IBS and enjoy the anancastic retreat this
    provides. Keep up your acknoledgement of their third CNS!

  14. Daniel Evans says:

    irritable bowel is quite annoying and you will really hate that disease.””~

  15. Barry says:

    I have also had a lot of success using hypnotherapy for Irritable Bowel Syndrome. One of hypnotherapy’s greatest benefits is its ability to reduce the effects of stress. Your state of mind can have a direct impact on your physical well-being.

  16. Donna Gates says:

    I was really happy to see the posting of Dr. Torres-Lisboa mentioning kefir. I work with people who have gut conditions and have for many years. i am mostly a researcher and a teacher but I specialize in probiotic FOODS. These are much more effective than probiotic SUPPLEMENTS.

    As an example, children with autism have gut issues and our parents make a fermented drink for them that we call kefir…young coconut kefir. We make it from the water inside the young Thai coconuts. The kids have wonderful results and many of the doctors here in the US and in Australia and New Zealand now recommend this drink after seeing the results. Also eating fermented vegetables is excellent for gut problems.

    At birth Nature tries to establish an “inner ecosystem” of beneficial microflora in our gut so that we can digest the foods we eat and to keep our intestines clean and healthy. The microflora in our gut do even more…including manufacturing B and K vitamins etc. communicating to the gut wall, communicating to each other…the list goes on and on. Sadly we are not taught to create and care for this inner world. Sugar, stress and antibiotics destroy it. Probiotic supplements are usually not hard enough to set it back in place but probiotic foods can.

    Though out our life we are meant to eat fermented foods to keep this healthy inner eco system thriving inside us. Probiotic foods will even improve the effectiveness of probiotic supplements.

    Unless there is a strong pathogen in the gut already…that has control of the environment…simply changing the diet and adding these fermented foods is very effective. If there’s a nasty pathogen we recommend someone take an antibiotic from their doctor and then start on the probiotic foods at the same time to prevent an overgrowth of yeast.

    Milk kefir is not recommended when there is a condition like IBS or colitis because when the gut is inflamed and “leaky” you don’t want casein leaking thru and causing reactions. Same is true for the protein gluten found in many grains. The other foods however are excellent. Since doctors are not trained to be nutritionists and even they are not trained in fermented foods i hope more and more patients come to you who are on these foods so you can see how effective they are.

  17. Donna Gates says:

    Just reread this post and realized the last sentence doesn’t make much sense. Someone on fermented foods probably won’t be in to see you. They won’t have IBS. What I should have said is that please ask your patient try fermented foods and then come back to you to report on the changes in their intestinal health. You’ll be pleased.

  18. Pete says:

    I am a registered dietitian and Professor of Dietetics who has studied/published regarding diet and GI function for 35 years and have treated many patients with IBS. Remember first that the placebo effect for Ibs is in the range of 40-50% so anything you do, especially with empathy will work– for a while. Dietary intolerance are indeed about 5 times more common in IBS folks than otherwise healthy individuals. and like the rest of Americans, they tend to eat the wrong things– too much overall, too much sugar, (and maybe sorbitol, lactose, fructose, caffeine, alcohol, fat, etc) but they likely suffer more. My first rule is to get them to eat a healthy diet in small doses– Americans don’t do that. Second exercise– Americans don’t do that on a regular basis.

  19. Anish Chopra, MD says:

    I am a GI fellow in my third year and have seen a handful of IBS cases. These patients have always intrigued me for the wide variety of presentations. However, i agree with the comments of medical student Kyle, and believe that IBS is a stress related disorder, i would say a social and emotional disorder.
    I agree that there are a lot of other factors like food sensitivity, post infectious process etc etc which may play a role but underlying stress due to wide variety of social/economic/emotional reasons plays a major part. Alternative therapies may be helpful and I have proposed to my PD / Chief about relaxation therapies for these patients. It is not feasible at our institute as it is inner city hospital and Medicaid/Medicare is not going to pay for it.

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