Irritable Bowel Syndrome (IBS) is one of our most significant healthcare burdens. Statistics from gastroenterology clinics indicate that IBS is the most commonly diagnosed GI condition and it comprises nearly 12% of primary physicians' patients. The related healthcare costs can add up greatly when considering how many individuals could be classified as having IBS. Estimates from studies in the U.S. show a prevalence rate between 10%-15%, which implies that up to 30 million Americans could meet the criteria for IBS. Diarrhea-predominant IBS (IBS-D) and mixed IBS (IBS-M) subtypes are more prevalent than constipation-predominant IBS (IBS-C).
Generally, IBS is defined by the presence of abdominal pain or discomfort that occurs along with altered bowel habits, occurring for at least three months. The accuracy of using individual symptoms to diagnose IBS is limited; for this reason, the disorder should be considered a complex of symptoms. The standard, historical management approach has relied on treating symptoms as they arise. Since the IBS patient population is very diverse, current therapies are usually limited to treating one symptom.
The good news is that there are emerging therapies for IBS, with newer agents capable of improving multiple symptoms simultaneously. The emerging advancements come as a result of our increasing understanding of the pathogenesis of IBS. By focusing on the molecular level, researchers have identified a variety of novel therapeutic agents that exert effects both peripherally and centrally. An example is Linzess (linaclotide), a guanylate cyclase-C agonist recently approved by the FDA to treat chronic idiopathic constipation and to treat IBS-C in adults. Linzess aids in the relief of constipation by helping create more frequent bowel movements. It may also help ease abdominal pain in cases of IBS-C, which is a subtype characterized by abdominal pain and hard or lumpy stools at least 25% of the time and loose/watery stools for less than 25% of the time. Results from two, double-blind studies showed Linzess was more effective than placebo in reducing the amount of abdominal pain and increasing the number of complete spontaneous bowel movements.
Keep current with information on products like Linzess by using PDR.net; a useful resource for alerts and specific product labeling. Be mindful that some commonly used drugs can trigger IBS-like symptoms in patients or can exacerbate the symptoms in those who already have an IBS diagnosis. Make sure to check PDR BRIEF and/or search in your EHR to brush up on the side effects/contraindications. Learn more about PDR in your EHR.
Salvatore Volpe, MD, FAAP, FACP, CHCQM
Chief Medical Officer
Occhipinti K, Smith J. Irritable Bowel Syndrome: A Review and Update. Clinics in Colon and Rectal Surgery 2012; 25:46-52.
American College of Gastroenterology Task Force on Irritable Bowel Syndrome. An Evidence-Based Systematic Review on the Management of Irritable Bowel Syndrome. Am J Gastroenterology 2009; 104:S1-S35.
U.S. Food and Drug Administration. FDA approves Linzess to treat certain cases of irritable bowel syndrome and constipation. August 30, 2012. http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm317505.htm.