Providing hope for IBS patients ‘is sometimes the greatest medication’
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Treating patients with irritable bowel syndrome can be a challenge for health care providers, as patients with suspected IBS often report a lengthy list of visceral and somatic symptoms that can overwhelm a busy provider.
Diagnostically, no test exists to confirm the diagnosis of IBS, which makes some health care providers uncomfortable making the diagnosis. Plus, no validated treatment algorithm exists.
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In this Healio Exclusive, several international experts in the field of disorders of gut-brain interaction provide their expert opinion on how to manage IBS patients using the most current evidence from literature. Guidelines from the ACG and the AGA provide evidence-based recommendations as well, although these guidelines are meant to support treatment decisions for IBS patients as a group, rather than for an individual.
The goal, of course, is to provide personalized care to each IBS patient. So, how can a busy health care provider accomplish that every day in clinic? And how can a clinician provide an outstanding patient experience at each visit?
The first step in providing an exceptional patient visit is to listen. Patients want to be heard. They want their story to be told. Taking time to listen to a patient’s story without interrupting in the first minute lets them know you are truly interested in helping them.
Step two is to educate the patient on their condition. As noted, IBS is a common disorder. Gently let patients know that many others have similar symptoms and that you, as the expert health care provider, have extensive experience treating these symptoms.
Three, reassure the patient that although symptoms of IBS can be burdensome, IBS never turns into something more dangerous such as inflammatory bowel disease, nor does it increase the risk for colorectal cancer. IBS does not shorten lifespan.
Four, inform patients that multiple treatment options are readily available to treat IBS symptoms. In addition to a variety of diets and over-the-counter agents, there are currently four FDA-approved therapies for the treatment of IBS with constipation and three FDA-approved therapies for IBS with diarrhea. There also is a growing body of evidence supporting the use of neuromodulators and brain-gut behavioral therapies.
Five, carefully review previous therapeutic endeavors. We have all been faced with the patient who states they have “tried everything” for their IBS symptoms. However, a thorough review of prior treatments frequently reveals that all therapies have not been employed, or that treatments were at suboptimal doses and for too short of a time to maximize benefits.
For example, there is now clear data showing that for the treatment of IBS with constipation, a therapeutic trial of less than 4 to 8 weeks may lead to at least 30% of patients being incompletely treated or undertreated. The key teaching point here is that a fair trial — both dose and duration — of each agent needs to be employed.
Six, providers should feel confident using augmentation therapy. For example, a low-FODMAP diet combined with a low-dose neuromodulator may prove effective for some patients with IBS and diarrhea, while a combination of a secretagogue and brain-gut behavioral therapy may improve patients with IBS and constipation symptoms.
Lastly, the astute clinician will let patients know that they will continue to do their best to help improve symptoms and won’t abandon them if the first, second or even third therapeutic endeavor fails. Providing hope to the patient is sometimes the greatest medication.
The physician Orison Swett Marden may have said it best: “There is no medicine like hope, no incentive so great and no tonic so powerful as expectation of something tomorrow.”
- References:
- Brenner DM, et al. Am J Gastroenterol. 2023;doi:10.14309/ajg.0000000000002064.
- Lacy BE. Tenapanor treatment success for IBS-C symptoms increases with duration of therapy. Presented at: ACG Annual Scientific Meeting; Oct. 20-25, 2023; Vancouver, British Columbia (hybrid meeting).
- For more information:
- Brian E. Lacy, MD, PhD, FACG, is professor of medicine, director of the GI fellow program and associate program director of scholarly activity at the Mayo Clinic in Jacksonville, Florida. He can be reached at lacy.brian@mayo.edu.
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