Shared Decision Making with IBS

IBS is a complex disorder that often requires a multi-faceted and personalized treatment plan.

From my experience, treatment bias plays a big role in how IBS patients are treated. Treatment Bias is a prejudice in favor of or against one treatment compared with another in a way that may be unfair or employed with a limited lens.

How about educating IBS patients about the various treatment options available to provide symptom relief? Then, they can be an educated participant in their own treatment plan. Seems so obvious, doesn’t it?

The patient-clinician partnership should be central to decision making. Clinicians should provide their clinical rationale for treatments offered to help educate the patient. This facilitates a team approach. The patient, of course, is an essential part of the team.

But often practitioner’s bias plays a role in what treatments are offered.

I believe, it is essential for IBS practitioner’s to stay abreast of the current research (this is a bit of a challenge as so many papers are published monthly) and help educate IBS patients on all evidenced-based options.

Last year at Digestive Disease Week (DDW), a group from the Netherlands presented on what I think is a wonderful project, called:  Reduce IBS Project: Multiple Therapy Choices and Shared Decision-Making Give IBS Patients Self Management and Better Quality of Life.

This pilot project evaluated the strategy of offering 10 IBS therapy options to patients and to have the patient select their top 3 choices for treatment.

Patients received electronic handouts of each therapeutic option so that they could educate themselves and then selected their 3 top options.

The 10 treatments offered included:

  • Broad IBS information
  • Elimination diet
  • FODMAP restricted diet
  • Probiotics
  • Hypnotherapy
  • Antibiotics
  • Peppermint oil
  • Spasmolytics (antispasmodics)
  • Amitriptyline (antidepressant)
  • Citalopram (antidepressant)

Patients were referred back to their GP who treated them with the 3 chosen treatments for 2 months.

In this pilot study, 217 IBS patients were included, 76% female.  The preferred therapy of choice were peppermint oil (51%), probiotics (49%), low FODMAP diet (46%), hypnotherapy (36%) and elimination diet (27%).

No surprise, patient’s appreciated having treatment options and their IBS quality of life symptoms improved by 13.7%. Time spent with the gastroenterologist was actually reduced from 45 minutes to 10 minutes. The number of colonoscopies was reduced as well from 25% to 15%.

This study reveals that nutritional treatment options are important to IBS patients. Comprehensive information about IBS therapies should be shared with IBS patients as well as adequate time to allow patients to ‘digest’ the different treatment options so they can select an option that is most suitable to their goals.

For the patient:  Does your IBS treatment team provide various options to help manage your symptoms? Or is it a one-size fits all approach?

For the practitioner: Does this article make you think about other options you might suggest or consider for your IBS patients?

Reference: DDW 2017 presentation 164. Otten, MH et al. Reduce IBS Project: Multiple Therapy Choices and Shared Decision-Making Give IBS patients Self Management and Better Quality of Life.





6 replies on “Shared Decision Making with IBS

  • Kim A

    In my personal experience it has always been antibiotics, low fodmap with nothing more than a list and no guidance on how to do it, and pump up your fiber. So yes, one size fits all, mostly in the form of antibiotics and a rushed visit. The last GI dismissed me the 2nd I refused more antibiotics, which was the trigger that put me over into SIBO to begin with.

    I have tried my share of drugs and supplements in the past, I do not do well on them. Fodmap would be great if I could eat most foods but with SIBO I can’t. It shouldn’t have gone this far for me and wouldn’t have if I had proper care from the beginning.

    We need not only to be listened to, as we know our bodies best, and have alternatives, but we also need management, customized to each individuals needs, lifestyle, income, etc. More DR’s and practitioners need to accept more insurances, so we can have quality medical care for this. How to schedule ourselves, how to do food elimination with ease and confidence, to know which foods should be in or out. To be educated on the relationship between stress and worry and our gut and how to help manage that in practical ,real life ways. Basically, we need a G.I. Coach. This goes way beyond just us and our DR’s, it involves a complete lifestyle review and solutions.
    Unfortunately they only look for the big scary stuff or the text book solutions. We need current and long-term support so it doesn’t debilitate living life and leading to much worse.

    I’m sure that is more than you wanted but IBS and SIBO are not black and white or text book to live with. Most “solutions” are bandaids or temporary. We need more.

    Thanks for listening.

    • katescarlata

      Fully agree. IBS and SIBO patients deserve more. Thanks for you for your thoughtful and thought-provoking comment. I love the idea of a GI coach–but he/she would absolutely need to truly understand the science.

      • Kim A

        Kate, I 100% agree, they would need to. If people in the medical community would get more creative and think outside the textbook box, maybe they would be willing to start training people to be able to truly understand the science and real life applications to help us. As long as there are DR’s and practitioners willing to work alongside them, this would be as possible as GI nutritionists and dieticians are but more helpful.

    • Fran

      You said it so beautifully. It is sad how our lives are textbook . We are the clinical study for there drugs and they get away with it.

      • Kim A

        Fran, that is often the case, very true. {{hugs}} for you and all of us dealing with these gut issues. 🙂

  • dkaj

    Kate, do you know if any of these options consider patients who have co-existing conditions like acid reflux, gastritis, or cross reactive allergies between foods and pollens on top of IBS. Seems like so much research is going into IBS which is wonderful, but this is mainly for IBS and SIBO. Unfortunately for some, there are these co-existing conditions that just get lumped into IBS without further consideration. So, if one is not completely diagnosed accurately, and given peppermint oil, this could be a reflux or gastritis trigger but safe for just IBS.

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