Review of the Patient Burden and Therapeutic Landscape of Irritable Bowel Syndrome with Constipation in the United States

Morgan Allyn Sendzischew Shane,1 Johannah Ruddy,2 Michael Cline,3 David P Rosenbaum,4 Susan Edelstein,4 Baharak Moshiree5 1Division of Gastroenterology and Digestive Disease, University of Miami, Miami, FL, USA; 2Patient Advocacy, Ardelyx, Inc., Waltham, MA, USA; 3Department of Gastroenterology, Cleveland Clinic, Cleveland, OH, USA; 4Clinical Research, Ardelyx, Inc., Waltham, MA, USA; 5Division of Gastroenterology, Advocate Health Wake Forest Medical University, Charlotte, NC, USACorrespondence: Baharak Moshiree, Advocate Health Wake Forest Medical University, Morehead Medical Plaza, 1025 Morehead Dr, Suite 300, Charlotte, NC, 28204, USA, Email Baha.Moshiree@atriumhealth.orgAbstract: Irritable bowel syndrome (IBS) is a common disorder of the gut–brain axis. IBS with constipation (IBS-C) accounts for approximately one-third of IBS cases and is associated with substantial burden of illness and decreased quality of life. This narrative review provides an overview of the current and upcoming treatment options and disease management for IBS-C from a US perspective and discusses the importance of the relationship between patient and health care provider in diagnosis and treatment. A positive diagnostic strategy for IBS-C is recommended, based on clinical history, physical examination, and minimal laboratory tests. An effective communication strategy between patients and health care professionals is essential to ensure early diagnosis and reduce both health care costs and overall disease burden. Treatment typically begins with lifestyle interventions and nonpharmacologic options, such as dietary interventions, fiber supplements, and osmotic laxatives. In patients with inadequate response to these therapies, 4 currently available therapies (lubiprostone, linaclotide, plecanatide, and tenapanor) approved by the US Food and Drug Administration may relieve IBS-C symptoms. These agents are generally well tolerated and efficacious in improving IBS-C symptoms, including constipation and abdominal pain. In patients with persistent abdominal pain and/or psychological symptoms, brain–gut behavioral therapy or neuromodulator therapy may be beneficial.Keywords: irritable bowel syndrome with predominant constipation, tenapanor, lubiprostone, linaclotide, plecanatide