Abstract:
Irritable bowel syndrome is a heterogenous disorder that affects gastrointestinal
tract. It is characterized by altered bowel habits and discomfort. The syndrome clinically
presents discomfort associated with abdominal pain; irregular stool patterns accompanied
with bloating. The prevalence of IBS in Pakistan is around 21% (Quddus et al., 2021). It
is difficult to diagnosis because no suitable biomarker is available. IBS is mainly treated
symptomatically. The study compares the efficacy of drug combinations i.e. (Rifaximin
+ Mebeverine), (Rifaximin + Amitriptyline) and (Rifaximin + Psyllium Husk) in
individuals suffering from IBS associated with diarrhea. It was conducted in National
Medical Center Karachi, during a period of six months on 162 diagnosed patients of
irritable bowel syndrome associated with diarrhea. Individuals of both genders, between
the age of 18-45 years were evaluated based on ROME IV criteria and included in the
study. Patients were divided into 3 groups each having 54 members. Each group was
given a treatment regime i.e., Group A: Tablet Rifaximin 550 mg and Tablet Mebeverine
135 mg, Group B: Tablet Rifaximin 550 mg and Tablet Amitriptyline 25mg Group C:
Tablet Rifaximin 550 mg and Psyllium Husk 15-30gm for 14 days. A Blood test was done
to check for problems like coeliac disease, thyroid profile to access thyroid related issues,
Fecal Calprotectin was done to differentiate between IBD and IBS and to rule out other
gastrointestinal infections. After written informed consent each patient experienced a
wash-out period of 72 hours. Parameters checked at 0 and 2 weeks were: abdominal pain
that coincides with alteration of bowel habits and diarrhea. Adverse effects of drugs were
also observed. The ANOVA test was used for statistical analysis. Significant results ( p
< 0.002) in parameter of severity of abdominal pain and ( p < 0.006) in parameter of
frequency of diarrhea on day 14 was shown among the groups. Significant differences
were also found in heartburn, bloating and dry mouth among the three groups while most
of the adverse effects showed non-significant results. The study concluded that
combination therapy of rifaximin and amitriptyline was clinically superior to other
regimes in management of IBS-D. Combination therapy had a better outcome with safety
profile as well as improved in the quality of life
