Emerging therapeutic devices for irritable bowel syndrome

January 10, 2025

A clinical state-of-the-art review highlighted several devices that have been investigated for IBS.

• Polymethylsiloxane polyhydrate (Enterosgel) is an orally consumed intestinal adsorbent that is classified as a medical device with no pharmacological action. In a randomized trial of 105 primary care patients with acute diarrhea, the Enterosgel group had shortened duration of diarrhea compared with the control (27 hours vs. 39 hours, HR, 1.74 (95% confidence interval [CI], 1.06 to 2.87); P = 0.03) with no adverse events. A multicenter trial of 440 patients with IBS-D showed that Enterosgel performed better than placebo in the composite primary outcome of pain reduction and stool consistency score (37.4% vs. 24.3% (OR, 1.95, NNT = 8, P = 0.002) and decreased stool urgency and frequency. Sixty percent of patients reported adequate relief of symptoms with no increase in adverse events. This over-the-counter therapeutic can be considered for treatment of IBS-D and warrants further investigation.
• Vagal nerve stimulation (auricular branch of the vagal nerve). Trials have shown improvement in quality of life and IBS pain scores as well as number of spontaneous bowel movements in an IBS-C cohort. A percutaneous auricular nerve stimulator (IB-STIM) has received FDA clearance for use in adolescents with functional abdominal pain-related disorder of gut-brain interactions, on the basis of a randomized, sham controlled trial (n = 115): 81% of the treatment group (vs. 26% of sham group) showed global symptom improvement after three weeks of treatment with greater reduction of worst pain scores compared with sham (P < 0.0001). The effect was sustained at 12 weeks follow-up. Side effects included ear discomfort, adhesive allergy, and syncope. This product is not yet available for adult IBS populations.
• Ingestible vibrating capsule. Vibrant has been approved for treatment of chronic idiopathic constipation based on study data showing improvement in number of complete spontaneous bowel movements, straining, stool consistency, and quality of life compared with placebo capsule, with similar results in a functional constipation population. Early evaluation of this capsule in patients with IBS-C and chronic constipation did not show statistically significant improvement in overall colonic transit compared with sham but at least 25% of the patients experienced increase in colonic transit speed. The utility of the vibrating capsule for IBS-C treatment requires further study.
• Virtual reality for IBS treatment is being studied with programming specifically targeted to gut-directed causes of pain, combining educational content, CBT techniques, and exposure therapies within an immersive virtual environment. Early studies show patient acceptance of the treatment modality, with further studies on efficacy and mechanism of action currently under way.

Source:

Wang XJ, et al. (2024, December 16). BMJ. Non-pharmaceutical treatments for irritable bowel syndrome. https://pubmed.ncbi.nlm.nih.gov/39681399/