How is irritable bowel syndrome (IBS) treated?

Updated: Dec 30, 2019
  • Author: Mohammad F El-Baba, MD; Chief Editor: Carmen Cuffari, MD  more...
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Answer

Irritable bowel syndrome (IBS) is a chronic illness and has no cure. [1]  Management options range from medications to cognitive behavioral therapy to hypnotherapy, [1]  and likely require multimodal pharmacologic and nonpharmacologic management. [3]

Treatment may be challenging and even frustrating to the physician, the patient, and the patient's family. The most important component of treatment is to establish an effective and therapeutic relationship with the patient and his or her family.

Educate the child and parents that irritable bowel syndrome is a chronic illness that cannot be cured. At the same time, reassure them that it is not a life-threatening condition and it does not lead to physical impairment. Tell the patient and the family that the symptoms are real and respond to their worries and concerns. Reassurance is more effective if offered after a careful history and physical examination and a conservative diagnostic evaluation.

Most patients have mild symptoms and maintain normal daily activities and regular school attendance. Address the possible dietary and psychosocial triggering factors. Counseling, dietary modifications, and lifestyle changes are usually effective and sufficient for treatment.

A smaller proportion of patients have moderate-to-severe symptoms with some disruption of their activities and school performance. This group of patients may benefit from pharmacotherapy and behavioral treatment, such as gut-directed hypnotherapy (HT). HT is a special form of hypnotherapy and is a well-established treatment for IBS. Vlieger et al studied the long-term effects of HT compared to standard medical treatment plus supportive medical therapy and found HT to have long-lasting beneficial effects (eg, decreased pain intensity and frequency) in children with IBS. [25] Referral to a psychologist may be required.

A recognized association exists between the development of irritable bowel syndrome (functional abdominal pain) and prior severe gastrointestinal infection. One study has shown that the administration of lactobacillus rhamnosus GG (LGG) significantly reduced the frequency and severity of abdominal pain in children with irritable bowel syndrome. [26]


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