Table 2.
Over-the-Counter and Prescription Treatments for Functional Bowel Disorders
| Treatment | NNT (95% CI)a | Benefits and Suggestions for Use |
|---|---|---|
| Over-the-counter agents | ||
| Fiber: psyllium | 4.5, NA 45 b | Start with low dose and increase gradually. Effects are not as pronounced as for laxatives and manifest over time |
| Laxatives: polyethylene glycol | NA, 3 (2–4) 45 b | More evidence in CC than IBS-C. Improved bowel symptoms but not abdominal pain in IBS-C57 |
| Antidiarrheals: loperamide | NA | Beneficial for diarrhea but not abdominal pain in IBS-D |
| Probiotics | 7 (4–12.5) 58 | Studies used different species, strains, preparations, and doses in various patient populations; therefore, results are challenging to interpret. Possibly beneficial for bloating and flatulence |
| Antispasmodics: peppermint oil | 3 (2–4) 58 | Improves abdominal pain and global symptom relief |
| Prescription medications | ||
| Antidepressants: TCAs, SSRIs, SNRIs | 4 (3–6) 58 | Use TCAs for IBS-D and SSRIs for IBS-C |
| Linaclotide | 7 (5–8), 6 (5–8) 59–61 | Improves abdominal pain, bloating, and global IBS symptoms in IBS-C |
| Lubiprostone | 13, 4 (3–7) 45 | Improves abdominal bloating, discomfort, constipation severity in opioid-induced constipation62 |
| Prucalopride | NA, 6 (5–9) 45 | Not approved for use in the United States |
| Antibiotics: rifaximin | 9 (6–12.5) 58 | Improves global symptoms, bloating, and abdominal pain in IBS |
| Clonidine | NA 63 | Improves bowel symptoms in IBS-D |
| Other therapies | ||
| Psychological and behavioral therapy | 4 (35) 64 | Cognitive behavioral therapy, hypnotherapy, dynamic psychotherapy, relaxation training, and multi-component psychological therapy all improved global symptoms in IBS |
Abbreviations: CC, chronic constipation; IBS, irritable bowel syndrome; IBS-C, irritable bowel syndrome of constipation type; IBS-D, irritable bowel syndrome of diarrhea type; NA, not available; SNRI, serotonin and norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor; TCA, tricyclic antidepressant.
a
NNT indicates number needed to treat for IBS unless specified otherwise.
b
NNT for IBS-C, chronic constipation.