Guidelines from the American College of Gastroenterology will have IBS patients and their doctors questioning what they thought they knew about keeping gut symptoms under control.

Finding the right treatment for irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC) can be overwhelming.

To narrow it down, the American College of Gastroenterology (ACG) has released a review of evidence about managing IBS and CIC. The review reevaluates popular treatments and shifts the focus to underrated but effective remedies, such as psyllium, probiotics, and antidepressants.

“There’s great potential for many of the treatments that have been used over time and need more studies,” said Dr. Lawrence Schiller, a gastroenterologist at Baylor University Medical Center in Dallas and a former president of the ACG. “Right now the evidence is fairly weak that they prove beneficial, but that’s largely due to the fact that they haven’t been studied that well in the modern sense.”

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The review summarized the results of many studies of different IBS treatments, looking at the strength of each recommendation and the quality of evidence to support each treatment.

For many common IBS therapies, “even though they may have a positive review … the evidence is weak,” Schiller said. That doesn’t mean that these treatments don’t work for some patients or deserve more exploration.

The review provides evidence to support treatments that have, until now, flown under the radar. The old stand-by of eating more fiber may be helpful in relieving IBS symptoms, but psyllium provides more relief than bran. Probiotics have been shown to improve symptoms of bloating and flatulence in IBS. And another treatment gaining popularity is the use of antidepressants in IBS management to keep a patient’s stress levels under control.

“The database [of evidence] has improved some, so we feel a bit stronger about using those agents in pain modification for people with IBS,” Schiller said.

Some of the treatments we’ve come to trust are based on old ways of thinking, Schiller said.

As the body of knowledge about IBS and CIC grows, different treatments will be used. “We make recommendations that make sense, but what makes sense might change from time to time,” Schiller said.

The effectiveness of treatment isn’t the only issue. “The biggest problem is proper identification in these patients,” Schiller said. Doctors may be quick to label many different symptoms as IBS, since IBS presents differently in each patient and there are no diagnostic tests for the condition.

This can lead to generalization in treatment for “any person who has a bellyache,” Schiller explained.

“Because IBS is so common, doctors frequently make that diagnosis without taking the time to make an effective diagnosis,” Schiller said.

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Even as more research becomes available, patients need to take control of their own health. IBS and CIC can be managed most effectively, Schiller said, when patients start talking to their doctors.

“Patients are often reluctant to discuss these things with their doctors,” Schiller said. “Things related to the bowels are still seen as taboo.”

Doctors also have a responsibility to bring up these issues. “The physician may not bring up pain or problems they’re having with too frequent or infrequent stools,” Schiller said.

Schiller encourages patients to document their symptoms and when they occur. Symptoms can flare up from eating certain foods or from stress at work or at home. It can be difficult to pinpoint the exact cause of IBS or CIC, so a look at a patient’s lifestyle as a whole provides the best answers.

“Careful record-keeping and going to the doctor are the best way to sort through these baffling symptoms,” Schiller said.

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