Pharmacologic treatment of irritable bowel syndrome. Position statement of the Asociación Mexicana de Gastroenterología, 2024.

K R García-Zermeño, E C Morel-Cerda, P C Gómez-Castaños, L R Valdovinos-García, A S Villar-Chávez, M Amieva-Balmori, M Schmulson, M E Icaza-Chávez, O Gómez-Escudero, R Carmona-Sánchez, A López-Colombo, E Coss-Adame, J M Remes-Troche, M Á Valdovinos-Díaz

Journal: Revista de gastroenterologia de Mexico (English) 2025;90(1):77-110

PMID: 40307155

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Abstract

INTRODUCTION

The aim of this position statement is to provide health professionals with an updated and evidence-based guideline for the pharmacologic management of irritable bowel syndrome (IBS) in Mexico.

MATERIAL AND METHODS

A literature review was conducted that included relevant guidelines and studies, up to the date of its publication. The mechanism of action, specific indications in IBS, safety profile, and availability of each therapeutic class were evaluated. The recommendations were developed by 14 experts, considering the clinical reality of IBS patients in Mexico.

RESULTS

Specific recommendations were issued for each class. Antispasmodics (alone or combined) are used as first-line therapy for pain management, whereas antidiarrheals, such as loperamide, are used for reducing diarrhea in diarrhea-predominant IBS (IBS-D) and laxatives are used for constipation in constipation-predominant IBS (IBS-C). 5-HT4 agonists (prucalopride and mosapride) are recommended in IBS-C and 5-HT3 antagonists (ondansetron) are recommended in IBS-D. Linaclotide is the only secretagogue available in Mexico and is used in IBS-C. Rifaximin-alpha stands out for its efficacy in a subgroup of patients with IBS-D or mixed IBS. Probiotics are conditionally recommended as adjuvant therapy due to heterogeneous evidence. Neuromodulators (tricyclic antidepressants, selective serotonin reuptake inhibitors, etc.) are recommended as second-line treatment for pain management. Mesalazine can be used in IBS-D, but the corresponding evidence is weak.

CONCLUSION

Overall, these recommendations provide a solid framework for personalizing treatment, based on the clinical characteristics of the Mexican patient with IBS.

Address: Laboratorio de Fisiología Digestiva y Motilidad Gastrointestinal, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico. Electronic address: [email protected].; Departamento de Gastroenterología, Laboratorio de Motilidad Gastrointestinal, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.; Laboratorio de Hígado, Páncreas y Motilidad (HIPAM), Unidad de Medicina Experimental Dr. Ruy Pérez Tamayo, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, Mexico.; Centro Integral de Gastroenterología y Motilidad Avanzada (CIGMA), Boca del Río, Veracruz, Mexico.; Laboratorio de Fisiología Digestiva y Motilidad Gastrointestinal, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico.; Servicio de Gastroenterología, Práctica privada, San Luis Potosí, Mexico.; Clínica de Gastroenterología, Endoscopia y Motilidad Gastrointestinal, Endoneurogastro, Hospital Ángeles Puebla, Puebla, Mexico.; Servicio de Gastroenterología y Endoscopia Gastrointestinal, Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Culiacán, Sinaloa, Mexico.; Hospital Christus Muguerza Faro del Mayab, Mérida, Yucatán, Mexico.; Hospital Ángeles Puebla, Puebla, Mexico.; Laboratorio de Motilidad Gastrointestinal, Hospital Civil Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico.; Servicio de Gastroenterología, Hospital Médica Sur, Mexico City, Mexico.; Servicio de Cirugía Experimental, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Instituto Politécnico Nacional, Escuela Superior de Medicina, Mexico City, Mexico.; Práctica privada, Hospital Ángeles Acoxpa, Mexico City, Mexico.

DOI: 10.1016/j.rgmxen.2024.10.009

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MeSH Terms: Humans, Antidiarrheals, Diarrhea, Gastrointestinal Agents, Irritable Bowel Syndrome, Mexico, Consensus