Finally, Long-lasting Relief for IBS Patients

A ground-breaking antibiotic therapy is the first potential drug treatment to provide irritable bowel syndrome patients (IBS) with long-lasting relief of their symptoms even after they stop taking the medication, according to a study published in the New England Journal of Medicine.

Unlike with other traditional therapies for IBS, patients in these large studies reported relief of their symptoms for up to 10 weeks after completing treatment with rifaximin, said William D. Chey, MD, of the University of Michigan Medical School, in a statement.

Rifaximin is a minimally absorbed antibiotic that stays in the gut. Specifically, patients reported improvement in overall IBS symptoms, relief from bloating, less abdominal pain and improved stool consistency for up to 10 weeks, according to Chey, who was one of the researchers on the study and director of the Michigan Bowel Control Program.

While the concept of bacteria playing a key role in this condition was controversial when first introduced a decade ago, this research confirms that the gut microbiome plays a role in the symptoms of IBS, a chronic condition affecting an estimated 30 million people in the US. The therapy was developed at Cedars-Sinai Medical Center.

These findings show that targeted antibiotics provide safe and effective long-lasting relief for this condition, according to the study's lead author, Mark Pimentel, MD, GI Motility Program director and principal investigator of the clinical trials at Cedars-Sinai.

“This represents a big change in the way we think about and treat IBS,” said Chey, adding that IBS often does not respond well to treatments currently available like dietary changes or fiber supplements alone. Patients also often see a return of symptoms once traditional medical treatments are stopped. But with this new treatment, the patients feel better and continue to feel better after stopping the drug.

In two, 600-plus patient double-blind trials, IBS patients with mild to moderate diarrhea and bloating were randomly assigned to take a 550 milligram dose of rifaximin or placebo three times daily for two weeks. Study participants were then followed for 10 weeks more. About 40% of patients who took the drug reported they had significant relief from bloating, abdominal pain and loose or watery stools. Further, that relief was sustained for weeks after completing treatment with the antibiotic.

Doctors commonly categorize IBS patients with a “constipation predominant” condition, a “diarrhea-predominant” condition, or a mixed pattern of diarrhea and constipation. In addition, patients often experience abdominal pain or cramps, excess gas or bloating, and visible abdominal distension.

Because the cause of the disease had been elusive, treatments for the disease historically have focused on relieving its symptoms with medications that either slow or speed up the digestive process. Earlier research documents a link between bloating, the most common symptom, and bacterial fermentation in the gut related to small intestine bacterial overgrowth, or SIBO. Other research has suggested that the bacteria which reside within the small and large intestines of IBS patients may be different than those inhabiting the intestines of healthy individuals.

Rifaximin is approved by the FDA to treat travelers’ diarrhea and hepatic encephalopathy.

To access the NEJM study, click here.