IBS with diarrhea (IBS-D) and bile acid diarrhea (BAD) have a greater effect on bowel and somatic symptoms and QOL compared with IBS-D without BAD, according to findings published in Clinical Gastroenterology and Hepatology. Researchers compared the demographics, bowel and somatic symptoms, and QOL of 219 patients with IBS-D, 44 of whom had BAD. Patients in the BAD group were significantly older, with a higher BMI than those without BAD, and had more severe bowel dysfunction and impact on IBS-QOL (need of toilet proximity). These patients were also more likely than other IBS-D groups to receive antidiarrheals, bile acid binders, and antacid secretory agents. Severity of diarrhea and need for toilet proximity were predictors of BAD in IBS-D (P<0.01), and patients with BAD were more likely to have a depression score of greater than 8 on the Hospital Anxiety and Depression Inventory.


Anti-Neuropathic Analgesics Demonstrate Benefit for Pain in IBS

Anti-neuropathic analgesics may improve pain in IBS, researchers reported in Neurogastroenterology & Motility. The study team performed a systematic review of existing evidence to examine the role of anti-neuropathic medicines in managing IBS pain that included 13 studies with 629 participants. The studies investigated amitriptyline (N=6), duloxetine (N=3), pregabalin (N=3), and gabapentin (N=1). Amitriptyline was most widely studied, though only in diarrhea-predominant patients. In individual trials, amitriptyline, pregabalin, and gabapentin commonly demonstrated benefit for pain outcomes; duloxetine studies usually reported improvements in pain but were all uncontrolled trials with a high risk of bias. A meta-analysis of three studies (N=278) yielded a pooled relative risk of 0.50 (95% CI, 0.38–0.66) for no improvement with an anti-neuropathic agent compared with control. Results indicate that anti-neuropathic analgesics may improve pain in IBS and warrant additional, high-quality research, potentially considering parenteral administration and agents with minimal gastrointestinal motility effects, the researchers noted.