What Adjunct Therapies Are Most Effective for IBS, IBD?

Certain adjunct therapies, such as the Mediterranean diet, physical activity, and cognitive behavioral therapy (CBT), may help reduce persistent digestive symptoms and improve quality of life in patients with irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD), according to a study.¹

The global prevalence of IBS and IBD, an umbrella term that includes Crohn disease (CD) and ulcerative colitis (UC), has grown dramatically, with the number of new IBD cases rising from 3.7 million in 1990 to 6.8 million in 2017. The analysis, published in Nutrients, sought to explore personalized care programs with adjunct therapies in addition to drug treatments and their impacts on patient quality of life and symptom burden.

The global prevalence of IBD, an umbrella term for Crohn disease and ulcerative colitis, has significantly increased, with new cases rising from 3.7 million in 1990 to 6.8 million in 2017. | Image credit: Grispb - stock.adobe.com

Although IBD and IBS present with similar symptoms, IBS is classified as a functional gastrointestinal disorder, whereas IBD is a disease.² Additionally, IBD is characterized destructive inflammation that can cause permanent damage to the intestines and an increased risk of colon cancer. IBS does not cause inflammation and rarely requires hospitalization or surgery, but can result in chronic or persistent abdominal pain, constipation and diarrhea, nausea, gas, mucus in stool, and more gastrointestinal symptoms.

The present scoping review analyzed the latest clinical practice recommendations and clinical trials on nonpharmaceutical therapies, such as diet changes, exercise, CBT, and medical nutrition therapies, including probiotics, soluble fibers, chitin-glucan, and micronutrients for digestive symptom relief.¹ The review looked at “quality of life improvements and nutritional deficiencies correction” as possible interventions as well.

While 50% of patients experience mild disease with infrequent relapses, the other half endure severe forms characterized by regular relapses, hospitalizations, surgery, and significantly reduced quality of life.

Even during remission, many patients with IBD report persistent digestive symptoms like IBS, such as abdominal pain, constipation, bloating, and diarrhea, which impair daily life. Notably, 40% to 60% of patients with CD and 46% of patients with UC experience IBS-like symptoms despite normalization of inflammatory markers. These symptoms are linked to higher rates of anxiety, depression, chronic fatigue, and sleep disturbances compared to the general population.

Fewer than half of patients with CD (38.5%) and UC (43.5%) feel their disease is well-controlled by treatment, citing issues like partial or lost treatment response, adverse effects, and recurring gastrointestinal symptoms, highlighting the need for personalized care plans, including adjunct therapies, to address ongoing symptoms and improve quality of life.

Furthermore, disparities in patient education and follow-ups with dietitians and health care practitioners underscore the importance of consistent and comprehensive care.

Standard of Care Drug Therapies

The standard drug treatments for IBS and IBD vary based on the condition and its severity. For IBS, first-line therapies include osmotic laxatives for constipation, loperamide for diarrhea, and antispasmodics for abdominal pain. Second-line options involve secretagogues like linaclotide, lubiprostone, and tenapanor for IBS with constipation (IBS-C) and eluxadoline or tricyclic antidepressants for IBS with diarrhea (IBS-D).

Across IBS, UC, and CD, persistent IBS-like symptoms, high rates of nonresponse or loss of response to treatment, and significant adverse effects contribute to reduced quality of life. Many patients experience ongoing anxiety, sleep disturbances, and chronic digestive issues. These challenges highlight the need for adjunct therapies to improve symptom management, enhance treatment efficacy, and address the unmet needs of patients.

Food and Diet Interventions

Several diets have been studied for managing digestive symptoms in IBD. A high-fiber diet may reduce CD risk and improve remission, with anti-inflammatory effects through butyrate, better microbiome health, and reduced intestinal permeability. The low fermentable carbohydrates diet has helped alleviate bloating, diarrhea, and abdominal pain in mild to moderate IBD. Vegetarian diets may affect psychological well-being, while gluten-free diets can improve symptoms and reduce fatigue, though long-term efficacy is unclear. The Mediterranean diet, rich in antioxidants, olive oil, and omega-3s, consistently reduces inflammation, improves microbiota, and boosts quality of life, with long-term adherence linked to lower CD risk and reduced mortality.

Regular exercise boosts mood, reduces fatigue, and improves sleep. It also decreases inflammation, relapse risk, and IBD onset while enhancing fitness and psychological well-being. Walking and moderate-intensity exercises are particularly effective. Barriers include fatigue, joint pain, and active symptoms.

CBT interventions can reduce anxiety, depression, and stress while improving coping skills and prolonging remission. Methods like mindfulness, hypnosis, and psychotherapy have shown significant improvements in quality of life and disease outcomes, especially for patients with active disease.

Medical nutrition therapies, such as chitin glucan and probiotics, offer benefits for managing IBS and IBD symptoms. Chitin glucan reduces inflammation and improves gut health, while probiotic strains like Bacillus coagulans and Bifidobacterium infantis, have also proven effective in alleviating symptoms like pain, bloating, and diarrhea. Studies show multi-strain probiotics and combinations with other treatments, such as simethicone, offer additional benefits. These therapies are valuable adjuncts to conventional treatments for digestive symptoms.

References

1. Adjunct therapies to standard care for IBS and IBD patients: digestive symptoms improvement and quality of life optimization. Nutrients. 2024;16(22):3927. doi:10.3390/nu16223927

2. IBS vs IBD. Crohn’s and Colitis Foundation. Accessed January 9, 2025. https://www.crohnscolitisfoundation.org/patientsandcaregivers/what-is-ibd/ibs-vs-ibd