Integrative and Evidence-Based Approaches to Managing IBS: Insights from Dr. Maitreyi Raman

Irritable Bowel Syndrome (IBS) is a complex and prevalent condition, affecting the lives of millions worldwide. In a recent Alethea Learning Session, Dr. Maitreyi Raman, a Gastroenterologist and leading expert in digestive health, shared her insights on managing IBS through integrative, evidence-based approaches. Her discussion covered everything from the pathophysiology of IBS to practical management strategies, offering primary care providers actionable tools to enhance patient outcomes.

Understanding IBS: Prevalence and Challenges

IBS affects approximately 12-20% of the global population, and its impact extends beyond physical symptoms. Patients often experience significant absenteeism and reduced productivity, with IBS accounting for 50% of gastroenterology consultations. Despite its prevalence, patients face an average of nine medical visits before receiving a diagnosis. This delay highlights the need for streamlined diagnostic approaches and effective management strategies.

Dr. Raman emphasized that IBS is now recognized as a disorder of gut-brain interaction, with factors like stress, microbiome dysbiosis, and diet playing critical roles. Diagnosis follows the ROME IV criteria, and subtypes include IBS-D (diarrhea predominant), IBS-C (constipation predominant), IBS-M (mixed), and IBS-U (unclassified). Excluding other conditions, such as celiac disease or pelvic floor dysfunction, is essential.

Integrative Management Strategies

Dr. Raman highlighted the importance of combining psychological, dietary, and lifestyle interventions with pharmacological treatments to address IBS holistically:

• Psychological Therapies: Cognitive Behavioral Therapy (CBT) and mind-body techniques like yoga and mindfulness significantly reduce symptoms.
• Dietary Interventions: The Low FODMAP diet and personalized Mediterranean diet can alleviate bloating and cramping. 
• Alternative Therapies: Psyllium fiber supplementation is strongly recommended at 25-35g per day, peppermint oil and a probiotic supplementation. 
• Pharmacological Options: Initial treatments may include osmotic laxatives and antispasmodics such as dicetel or Buscopan. If symptoms persist, prucalopride or rifaximin can be considered as second-line options. For patients requiring more targeted therapy, low-dose tricyclic antidepressants, Linaclotide or other secretagogues, and Eluxadoline may provide additional relief.
• Lifestyle Modifications: Exercise, stress reduction, and sleep optimization are foundational for symptom management.

Special Populations and Considerations

Dr. Raman also highlighted tailored approaches for unique patient groups:

• SIBO (Small Intestinal Bacterial Overgrowth): Significant overlap with IBS-D patients, treated empirically with antibiotics like Rifaximin.
• Pediatrics: Focus on fiber, Mediterranean diets, psychological therapies and lifestyle adjustments over restrictive diets due to growth and micronutrient deficiency concerns.
• Pregnancy: Be cautious to make a new diagnosis during pregnancy due to symptom overlap. It is common to see symptoms flare up, however here we would prioritize non-pharmacological interventions for concern of fetal malformations, unless absolutely necessary. Also restrict any endoscopic investigations during pregnancy. 

The Role of Digital Tools in IBS Management

Dr. Raman introduced LyfeMD, a digital health platform co-founded by her, designed to support IBS patients holistically. This 12-week program integrates tailored diet plans, yoga, mindfulness, and professional coaching. Recent studies have shown LyfeMD significantly improves IBS severity, anxiety, and quality of life.

Alethea users can refer IBS patients to LyfeMD by selecting "IBS" under the Gastroenterology drop-down menu on the platform and choosing Dr. Jacqueline Jenkins as a consultant. This streamlined process helps ensure patients receive expert guidance and personalized care.

IBS presents significant challenges for patients and healthcare providers alike. By targeting central mechanisms like the brain-gut axis and gut microbiome, integrative approaches offer hope for improving outcomes. Combining evidence-based tools like dietary modifications, psychological therapies, and digital platforms such as LyfeMD empowers providers to deliver more personalized, holistic care. For those who missed the session, learning notes are available under Dr. Jacqueline Jenkins’ profile on our website here. Providers can also request the video recording by emailing sales@aletheamedical.com.