Some Ibs Treatments May Be Linked To Slightly Higher Risk Of Early Death

• Researchers say some medications prescribed for irritable bowel syndrome (IBS) may increase a person’s risk of early death.
• However, experts say that risk is relatively small and the benefits of using medication to ease the discomfort of IBS outweighs these concerns.
• They add that people with IBS can also manage symptoms by adhering to a diet that minimizes trigger foods, as well as exercising daily and managing stress.

Some medications commonly prescribed to treat symptoms of irritable bowel syndrome (IBS) may increase the long-term risk of early death, a new study reports.

Scientists from Cedars-Sinai Health Sciences University in Los Angeles say that long-term use of two of the medications — loperamide and diphenoxylate — is associated with approximately double the risk of death.

They added that long-term use of antidepressants to treat IBS symptoms was associated with a 35% higher risk of death.

However, the researchers noted that although the overall increase in risk is statistically significant, the risk to any individual is small.

“IBS patients should not panic, but they do need to understand and weigh the small but meaningful risks when considering long-term treatments,” said Ali Rezaie, MD, the medical director of the GI Motility Program at Cedars-Sinai and senior author of the study, in a statement.

Nonetheless, Rezaie said the findings, published on April 8 in Communications Medicine, are noteworthy.

“Many patients are diagnosed with IBS at a young age and may remain on medications for years,” Rezaie said. “However, most clinical trials of these medications last less than a year, so we know very little about their long-term safety. This study begins to address that gap.”

Rudolph Bedford, MD, a gastroenterologist at Providence Saint John’s Health Center in Santa Monica, CA, said that the research only establishes an association between IBS medications and risk of death and not a direct cause-and-effect relationship. Bedford wasn’t involved in the study.

“The risk to any one person is small, so there is no reason to panic,” he told Healthline.

Bedford added that the symptoms of IBS can be painful and even debilitating, so in many cases, the medications do far more good than harm. “It’s about quality of life at the end of the day,” he said. “The benefits definitely outweigh the risks for many patients.”

Long-term health risks of IBS medications

The Cedars-Sinai researchers reached their conclusions after examining two decades of health records from nearly 670,000 adults in the United States.

They said their research is the largest real-world study to examine the long-term safety of IBS treatments.

Researchers looked at study participants who were taking IBS medications approved by the Food and Drug Administration (FDA), as well as antidepressants, antispasmodics, and opioid-based antidiarrheal drugs such as loperamide and diphenoxylate.

They acknowledged their study did not establish that these medications directly cause death. Instead, they said the observed associations may reflect higher rates of adverse outcomes, such as cardiovascular events, falls, and stroke.

They added that some medications, including antispasmodics and treatments for constipation, were not found to have an association with an increased risk of all-cause mortality.

Ketan Thanki, MD, a colorectal surgeon specializing in benign and malignant disease of the colon, rectum, and anus at the MemorialCare Todd Cancer Institute at Long Beach Medical Center, said further research is needed before any specific conclusions can be drawn. Thanki wasn’t involved in the study.

“For now, we should still approach these findings with caution,” he told Healthline. “As the authors point out, correlation does not imply causation, and further examination of the data and additional studies are needed to determine whether other factors are also involved.”

Nonetheless, Thanki said people with IBS should be aware of these findings.

“People who take IBS medications should certainly not panic,” he said. “However, they should ask their physicians if they have other risk factors, which may also correlate to negative outcomes when taking the particular drugs they are on.”

Bedford agreed with this assessment. “Patients and medical professionals need to be educated and be cognizant of the potential long-term effects. They shouldn’t have a cavalier attitude about it,” he said.

What to know about IBS

It’s estimated that 25–45 million people in the United States have IBS.

Of those, about 31% report having mild IBS symptoms, while 48% say they have moderate symptoms, and 20% state they have severe symptoms that can affect daily life.

Irritable bowel syndrome (IBS) is a functional GI condition, which means it’s caused by brain-gut interaction. It is a separate condition from inflammatory bowel disease (IBD).

The cause of IBS isn’t known, but it is associated with a number of factors. These include:

• stressful events early in life
• bacterial infections
• food intolerances
• anxiety
• depression

Some symptoms of IBS are similar to those of small bacterial overgrowth (SIBO). This digestive condition is sometimes misdiagnosed as IBS.

Common symptoms of IBS include:

• diarrhea
• constipation
• abdominal pain

There are a number of treatments for IBS symptoms. They include:

• dietary changes, including eating more fiber and avoiding gluten
• regular exercise
• stress reduction
• quality sleep
• medications

Acupuncture has been tested as a potential treatment for IBS, but the results so far have been mixed.

IBS was once thought to be a condition that mostly affected younger people, but medical experts now say it can also affect older adults.

Tips to help manage IBS symptoms

Experts say there are pharmaceuticals as well as lifestyle habits that can help manage IBS symptoms.

Bedford said medications can help in several ways. Among them:

• pain reduction
• lessening of cramps
• decreasing diarrhea
• loosening constipation

“Medications are all about treating symptoms,” he said.

Bedford said there are also several ways a person can improve symptoms through lifestyle changes. They include:

• stress management
• daily exercise
• low FODMAP diet, which minimizes the types of sugar the body may have difficulty digesting
• behavioral therapy to improve brain-gut interactions
• probiotics

Thanki said diet is one of the most important aspects of any treatment routine.

“Start with dietary modification — low-FODMAP trial with dietitian guidance, add fiber, reduce fats, eat smaller portions, limit caffeine and alcohol, and avoid personal trigger foods. This is one of the most effective ways to manage IBS,” he said.

“Add regular exercise and address sleep,” Thanki continued. “Assess for psychological comorbidities and consider gut-directed therapy such as hypnotherapy or cognitive behavioral therapy (CBT) and stress management. Lastly, an underutilized tool is addressing pelvic floor dysfunction with physical therapy and biofeedback.“