ADEN UMR-U1073 ;
CHRU de Rouen,
Hôpital Charles Nicolle
1, rue de Germont
76031 Rouen Cedex ;
Membres du Groupe Francophone de Neuro-Gastroentérologie (GFNG)
The main objective of the treatment is the relief of both abdominal pain and constipation, the latter being beneficial for the improvement of bloating. With a moderate intake of soluble fibers, laxatives and anti-spasmodics are the first line of treatment. However, the symptomatic efficacy in IBS-C remains to be better documented while the efficacy of both bedeillite montmorillonnite and alverine citrate has been shown in recent trials fulfilling the Rome II or III standards.
Agents effective on neuropathic pain can be used in case of failure of these first-line treatments even if the prevalence of visceral hypersensitivity is the lowest in IBS-C patients. If indicated, serotonin re-uptake inhibitors seem a better option than tricyclic agents. Treatments targetting intestinal microflora (i.e. probiotics, prebiotics and even antibiotics) have been mainly tested in IBS-D patients with controversial results while their efficacy in IBS-C remains to be documented.
Linaclotide, a guanylate cyclase agonist, is a new available option with both antinociceptive and laxative effects. Phase II then large phase III trials have proven its efficacy at a daily dose of 290 μg, both when FDA and EMEA endpoints are considered. The symptomatic effect is obtained with minimal side effects. The symptomatic efficacy of other drug options, i.e prucalopride and lubiprostone, have been more assessed in functional constipation than in IBS-C.