Brian Lacy, MD, PhD: Tailoring Treatment Experiences for IBS-C Patients

Irritable bowel syndrome (IBS) is an imperfectly managed condition. A number of unique pathway-target treatment options and cost-effective methods of symptom relief exist, but there is no great catch-all for the highly prevalent gastric disease.

But still, the armamentarium is growing vastly and quickly enough that a specialist may have the means to get more creative than they already are.

In the second segment of an interview with HCPLive during the American College of Gastroenterology (ACG) 2023 Annual Scientific Meeting in Vancouver, BC this week, Brian E. Lacy, MD, PhD, of the Mayo Clinic in Jacksonville, continued a discussion regarding tenapanor’s benefit for patients with IBS with constipation (IBS-C) by discussing the overall frustrating components of managing the chronic disease as both a provider and patient.

“We don't have a single agent that is effective for all IBS with constipation patients,” Lacy said. “I wish we did, but we don't. And we know that physiologically, patients are different. We know that different patients respond to different medications.”

Lacy explained a major component of his discussions with patients is to identify opportunities to personalize care; establishing a number of factors that which could influence treatment response and disease management could include any of these physician-to-patient questions:

• What have you taken before?
• What side effects did you experience?
• What are your goals and expectations from treatment?
• Do you understand the likelihood of response to this treatment?
• Do you understand how long this treatment generally takes to provide benefit?
• Do you understand the side effects associated with this treatment?

Lacy advocated for greater implementation of augmented therapy plans: combination pharmaceutical, diet and behavioral planning that reflects the patient’s current disease status.

“If somebody's partially responded to diet therapy, but not completely, don't necessarily stop the diet—but layer on something else,” Lacy said. “If somebody's partially responded, as an example, to tenapanor, but bloating isn't quite controlled, maybe layer on a new diet. And so you can imagine a number of different combinations of medications with diet.”

Lacy pointed to polyethylene glycol agents including Miralax—a common chronic constipation treatment that’s highly effective, safe and affordable. But for a patient with IBS-C, it may not be enough to address the key symptoms of abdominal pain and bloating.

“And so part of the dialogue with any IBS with constipation patient is setting expectations, but also limitations of certain medications,” Lacy said. “And when I think about treating the IBS patient, I want to think about global symptom relief: constipation, but the cardinal symptoms of abdominal pain and discomfort, and also bloating.”

Regarding tenapanor, Lacy expressed interest in observing its benefit to treat and relieve symptoms of constipation across other potential spaces—including patients with chronic constiptation, or those who experience it as a comorbidity due to Parkinson disease or opioid-induced constipation.

“That will require large studies to lead to FDA approval, but it’s certainly very interesting,” Lacy said. “And don't forget too—this medication has been shown to improve visceral pain. So is there something going on that maybe we could use this for other painful conditions, as well?”