Irritable bowel syndrome is a functional gastrointestinal disorder defined by abdominal discomfort associated with either symptom relief by defecation or symptoms related to stool form changes. As of 2015, the condition had a global prevalence of 11.2%, which had remained constant for the last 30 years (Endo, Shoji, & Fukudo, 2015). Furthermore, the odd ratio of IBS increased in comparison to men, while the prevalence was in no way associated with the socioeconomic statuses of individuals. The relative difference in terms of prevalence between sexes reflects a 5% absolute difference. The prevalence was 25% lower in adults above 50. Irritable bowel syndrome is associated with other conditions such as chronic fatigue syndrome, functional dyspepsia, gastroesophageal reflux disease, and psychiatric disorders such as anxiety and depression.
Treatment Goals for the Patient
The treatment goals are to reduce the severity of the symptoms without the risk of adverse reactions from drug therapy and improve the quality of life (Wilkins, Pepitone, Alex, & Schade, 2012). The patient will also need to be ensured for psychological health and proper diet practices. The goal is to relieve the patient of intermittent diarrhea and the cramping discomfort, hence reduce the overall symptoms.
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The first line and second-line drug therapy for IBS
First-line drug therapy involves the administration of loperamide, which effectively decreases stool frequency while increasing its consistency. Loperamide functions by reducing the intestinal transit and enhances the water and ion absorption. It is a synthetic peripheral µ -opioid receptor agonist that inhibits peristalsis and has anti-secretory effects (Lucak, Chang, Halpert, & Harris,2017). Additionally, it improves stool consistency and decreases frequency. Its side effects include constipation, nausea, and dizziness. Second-line drug therapy would involve Alosetron (Lotronex) for severe diarrhea-predominant in women. It relieves abdominal pains and reduces frequency as well as urgency. Starting dose requires 0.5 mg BID, which may be increased to 1 mg BID after four weeks under great toleration of the first dose. Adverse effects of Alosetron include ischemic colitis and constipation.
References
Endo, Y., Shoji, T., & Fukudo, S. (2015). Epidemiology of irritable bowel syndrome. Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology, 28(2), 158.
Lucak, S., Chang, L., Halpert, A., & Harris, L. A. (2017). Current and emergent pharmacologic treatments for irritable bowel syndrome with diarrhea: evidence-based treatment in practice. Therapeutic advances in gastroenterology, 10(2), 253-275.
Wilkins, T., Pepitone, C., Alex, B., & Schade, R. R. (2012, September 1). Diagnosis and Management of IBS in Adults. Retrieved from https://www.aafp.org/afp/2012/0901/p419.html
