Musculotropic antispasmodics (pinaverium bromide, alverine citrate) are indicated to relieve abdominal pain in IBS-D by reducing intestinal muscle contractions. They must be used occasionally (attention, peppermint oil is unproven in recent rigorous studies).
Loperamidewhich slows down intestinal transit, is recommended for transit disorders linked to IBS-D and FD. It reduces the frequency of bowel movements but has no effect on abdominal pain.
The combination of xyloglucan and xylo-oligosaccharides (Gelsectan)which acts by forming a film on the intestinal wall, showed greater effectiveness than placebo in patients with IBS-D, and a significant improvement in stool consistency.
Finally, probiotics may provide relief in some patients with IBS-D by improving symptoms and diarrhea (but the level of evidence is low).
And low FODMAP diet
is recommended in case of failure of initial treatments in IBS-D. This restrictive diet must be followed for 4 to 6 weeks; then, a gradual reintroduction of foods is recommended based on individual tolerance.
Cognitive-behavioral therapies and hypnosis have shown interest in the management of functional intestinal symptoms linked to IBS-D.
Finally, tricyclic antidepressantsused at low doses (in particularamitriptyline and theimipramine), may improve the pain and psychological disorders associated with IBS-D.
On the other hand, are not recommended by experts:
- The gluten-free diet: the possible effectiveness of a gluten-free, or low-gluten, diet is probably more linked to a reduction in FODMAPs associated with gluten than to a reduction in gluten.
- Selective serotonin reuptake inhibitors (SSRIs).
- Fecal transplantation.
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