Treatment of Irritable Bowel Syndrome with Diarrhoea (IBS-D)
Irritable bowel syndrome is subtyped by predominant stool pattern, and that subtype directly guides therapy. This protocol is for patients whose predominant pattern is diarrhoea — IBS-D — a presentation that calls for a directed treatment approach distinct from other IBS subtypes.
Clinical Scenario
Patients subgrouped by their predominant stool pattern into IBS with diarrhoea (IBS-D). Stool-pattern subtyping — IBS-D, IBS-C, IBS-M, or IBS-U — is used specifically to direct therapy toward the appropriate intervention.
Treatment Approach
Management focuses on an antidiarrhoeal agent, with particular attention to tolerability — dosing requires careful adjustment to minimise adverse effects while maintaining effectiveness.
The complete regimen and titration guidance are in the full protocol below.
Treatment Goals
- Improvement in stool frequency
- Improvement in stool consistency
References
DOI: 10.1136/gutjnl-2021-324598
- Patients are subgrouped according to their predominant stool pattern into IBS with diarrhoea (IBS-D), IBS with constipation (IBS-C), IBS with mixed bowel habits (IBS-M) or IBS unclassified (IBS-U), to direct therapy.
- Loperamide may be an effective treatment for diarrhoea in IBS. However, abdominal pain, bloating, nausea and constipation are common, and may limit tolerability. Titrating the dose carefully may avoid this (recommendation: strong; quality of evidence: very low).
- Although the drug improved stool frequency and consistency, it had no effect on global symptoms (RR 0.44; 95% CI 0.14 to 1.42).
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