[Treatment of Irritable Bowel Syndrome with Predominant Diarrhea].

Abstract

Irritable bowel syndrome with predominant diarrhea (IBS-D) is a subtype of irritable bowel syndrome that causes frequent loose stools. Although the precise pathophysiology remains unclear, factors, such as gut microbiota imbalance, visceral hypersensitivity, intestinal permeability changes, and stress, play significant roles. Recent studies have suggested that dysbiosis is a key contributor to IBS-D pathogenesis, emphasizing the need for targeted therapeutic strategies. The treatment of IBS-D involves pharmacological and non-pharmacological approaches. Pharmacological treatments include antidiarrheal agents, such as loperamide, which reduce stool frequency but have limited effects on pain relief. Antispasmodics, such as octylonium bromide and hyoscine butylbromide, alleviate abdominal pain by modulating intestinal motility. Rifaximin, a non-absorbable antibiotic, has shown efficacy in symptom reduction by altering the gut microbiota. Selective serotonin receptor antagonists, such as ramosetron, have benefits in symptom control, particularly in male patients. In addition, low-dose tricyclic antidepressants help manage pain and stool irregularities by modulating the gut-brain interactions. Non-pharmacological strategies include dietary modifications, with the low-FODMAP diet showing potential benefits despite concerns about long-term nutritional adequacy. Psychological interventions, such as cognitive behavioral therapy and gut-directed hypnotherapy, are recommended for patients with persistent symptoms unresponsive to medication. Mild physical activities, such as yoga and walking, relieve symptoms by improving gut motility and reducing stress. Personalized treatment approaches are essential because IBS-D presents a wide spectrum of symptoms. Clinicians should tailor therapeutic plans based on individual patient characteristics, balancing the benefits and risks of each intervention to optimize symptom control and improve the quality of life.