SYMPOSIUM REPORT: An Evidence-Based Approach to IBS and CIC: Applying New Advances to Daily Practice: A Review of an Adjunct Clinical Symposium of the American College of Gastroenterology Meeting October 16, 2016 • Las Vegas, Nevada

Abstract

Many nonpharmacologic and pharmacologic therapies are available to manage irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC). The American College of Gastroenterology (ACG) regularly publishes reviews on IBS and CIC therapies. The most recent of these reviews was published by the ACG Task Force on the Management of Functional Bowel Disorders in 2014. The key objective of this review was to evaluate the efficacy of therapies for IBS or CIC compared with placebo or no treatment in randomized controlled trials. Evidence-based approaches to managing diarrhea-predominant IBS include dietary measures, such as a diet low in gluten and fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs); loperamide; antispasmodics; peppermint oil; probiotics; tricyclic antidepressants; alosetron; eluxadoline, and rifaximin. Evidence-based approaches to managing constipation-predominant IBS and CIC include fiber, stimulant laxatives, polyethylene glycol, selective serotonin reuptake inhibitors, lubiprostone, and guanylate cyclase agonists. With the growing evidence base for IBS and CIC therapies, it has become increasingly important for clinicians to assess the quality of evidence and understand how to apply it to the care of individual patients.

Figure 1.

Interpreting the quality of the recommendation. Adapted from Ford AC et al. Am J Gastroenterol. 2014;109(suppl 1):S2-S26; quiz S27.

Figure 2.

Mean daily symptom scores over treatment weeks 3 and 4. BSF, Bristol Stool Form; FODMAP, fermentable oligo-, di-, and monosaccharides and polyols. Adapted from Eswaran SL et al. Am J Gastroenterol. 2016;111(12):1824-1832.

Figure 3.

Symptom reduction at day 29 after treatment with triple-coated peppermint oil. TID, 3 times daily. Adapted from Cash BD et al. Dig Dis Sci. 2016;61(2):560-571.

Figure 4.

Primary endpoint in eluxadoline pivotal trials. BID, twice daily. Adapted from Lembo AJ et al. N Engl J Med. 2016;374(3): 242-253.

Figure 5.

Data from the TARGET 3 trial. Patient disposition (left) and proportion of composite abdominal pain and stool consistency responders (primary endpoint; right). Response was defined as ≥30% improvement baseline in the weekly average abdominal pain score and ≥50% reduction in the number of days per week with a daily stool consistency of Bristol Stool Form Scale type 6 or 7. TID, 3 times daily. Adapted from Lembo AJ et al. 2014 ACG Abstract 45, and Xifaxan [package insert]. Salix Pharmaceuticals: Bridgewater, NJ: 2015.

Figure 6.

Percent change in abdominal bloating from baseline by week. BL, baseline. Adapted from Lacy BE et al. PLoS One. 2015;10(7):e0134349.

Figure 7.

Proportion of durable CSBM responders with plecanatide in CIC. CIC, chronic idiopathic constipation; CSBM, complete spontaneous bowel movements; ITT, intent-to-treat; QD, once daily. Adapted from Miner PB et al. 2016 DDW abstract SA1440, and Miner PB et al. 2016 DDW abstract SA1444.