Irritable bowel syndrome is one of the most common problems in the digestive system, and affects about 10%–15% of the population. It may not be considered a life-threatening disease, but for many it significantly impairs quality of life and manifests in abdominal pain, bloating, diarrhea or constipation.
Because of the chronic nature of the syndrome, many patients take medications over time. But how safe is this treatment really?
A new and particularly large study recently published examined this question, and the results raise concern.
More than 600 thousand patients, and a complex picture
The researchers analyzed data from more than 669 thousand patients with irritable bowel syndrome, over nearly two decades. They compared patients who received different medications with those who did not, and examined one central measure: Mortality from any cause.
The scope of the data and the long follow-up make the findings particularly relevant to the real world, unlike short clinical studies.
One of the main findings in the study was a consistent link between the use of antidepressant medications and an increased risk of mortality. Patients who took these medications showed an increase of about 35% in mortality risk compared to patients who did not take them.
This link appeared in almost every group examined. Whether men or women, young or old, all types of antidepressants. In some medications, such as mirtazapine, the risk was even higher. Another finding that strengthens the picture: The longer the use of the medications, the higher the risk.
In patients with irritable bowel syndrome accompanied by diarrhea, worrying findings were also found regarding very common medications: Loperamide (Imodium) and diphenoxylate, two medications that many use, were found to be associated with a significant increase in mortality risk.
These are medications considered relatively safe for short-term use, but it is possible that prolonged use is not without risk.
The good news: There are also treatments that appear safe
The study found that several common treatments were not associated with increased mortality, including:● Antispasmodic medications (such as dicyclomine)● Rifaximin (Lorimyx)● Bile acid binders● Constipation medications, such as PEG and medications from the secretagogue family, for example linaclotide and lubiprostone, were not linked in the study to increased mortality. These medications work by increasing fluid secretion into the intestine, thereby helping to soften stools and relieve constipation.
These findings are important because they can help doctors and patients choose safer treatment over time.
Why does this happen?The study does not prove a direct cause, but there are several possible explanations.Antidepressants may affect different systems in the body, for example:● Cause arrhythmias● Increase blood pressure● Increase risk of falls● Increase risk of bleeding● Affect weight and metabolismLoperamide, especially with prolonged use or at high doses, has also been previously linked to dangerous cardiac arrhythmias.
Do not stop treatment on your own
Despite the findings, it is important to emphasize, the study does not say that medications should be stopped. But it does emphasize an important principle: Chronic medication treatment should be re-evaluated over time, and not given “automatically” for many years.
One of the most important points that arises indirectly from this study is that irritable bowel syndrome is not one clear disease, but rather an umbrella term for a variety of different conditions. Two people can receive the same diagnosis: “Irritable bowel”, but the cause of their symptoms will be completely different.
In one person it may be dysbiosis (an imbalance of the microbiome), in another sensitivity to certain foods, in a third a hidden inflammation, and in a fourth the effect of environmental exposures.
When irritable bowel syndrome is treated only as a “label”, it is very easy to reach a situation where only the symptoms are treated, and not the problem itself.
There is another way
In functional medicine, the approach is completely different. Instead of asking “Which medication will relieve the symptoms?”, the central question is: Why did the symptoms appear in the first place?
The evaluation includes a broader view, for example:● The state of the gut microbiome● Responses to food● Environmental exposures● Nervous system function● Metabolic and inflammatory markers
The goal is to identify the root cause, and not settle for a general diagnosis.
The meaning is not necessarily to avoid medications, but to use them wisely, and at the same time try to understand what lies behind the symptoms. In many cases, when the deeper causes are addressed, it is possible to reduce dependence on medications, and sometimes even stop them completely.
This study raises important questions about the safety of some of the most common medications for irritable bowel syndrome, especially antidepressants and certain anti-diarrheal drugs. But perhaps the more important message is broader: Irritable bowel is not an endpoint of evaluation, but a starting point. And in order to achieve real and long-term improvement, it is necessary not only to relieve the symptoms, but to understand what lies behind them.
Dr. Dalit Draiman-Medina is a specialist in family medicine and integrative and functional medicine
Source:
www.jpost.com
