The American Gastroenterological Association (AGA) has published clinical guidelines for drug therapy for irritable bowel syndrome with diarrhea. To treat the disease, experts recommend the use of eluxadoline, rifaximin, alosetron, loperamide, tricyclic antidepressants, selective serotonin reuptake inhibitors and antispasmodics.
The AGA has updated its recommendations for the treatment of irritable bowel syndrome with diarrhea. The document was published in the journal Gastroenterology. The previous version of the guide was published in 2014.
Experts note that the worldwide prevalence of irritable bowel syndrome is 4.1% according to the Rome IV criteria. However, irritable bowel syndrome with diarrhea is the most common subtype of the disease, accounting for 30-40% of all cases.
For the treatment of irritable bowel syndrome with diarrhea, the AGA recommends the use of eluxadoline. The drug is prescribed in a dosage of 100 mg twice a day. In case of liver dysfunction, the dosage is reduced to 75 mg. Eluxadoline is contraindicated in post-cholecystectomy patients and in those who drink more than three alcoholic drinks per day.
In addition, to treat the disease, experts recommend prescribing rifaximin 550 mg three times a day for 14 days. If symptoms recur in patients who have responded to rifaximin, repeat therapy at the same dosage is indicated. It is possible to prescribe two repeated courses.
Alosetron can be used to treat severe irritable bowel syndrome with diarrhea in women, but careful monitoring of the risk of constipation and ischemic colitis is necessary when prescribing it.
It is also possible to prescribe loperamide, but there is insufficient data on the effectiveness of its use.
Recommendations for the use of tricyclic antidepressants, selective serotonin reuptake inhibitors and antispasmodics remained unchanged.