Condition

Irritable Bowel Syndrome

IBS - Chronic digestive disorder causing abdominal pain

800M
People Affected
14
Active Trials
64M
New Cases/Year
1,000
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Low FODMAP Diet
75% Effectiveness• 85% Confidence• 90% Safety• 78 trials• 5K participants
MODERATE EvidenceExcellent ValueDose: Adherence to dietary guidelines, often with dietitian guidance
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
90
DangerousModerateSafe

Time to Effect

1-4 weeks

Duration

Initial elimination (2-6 weeks), reintroduction (6-8 weeks), personalized long-term

Response Rate

60%

Remission Rate

35%

Number Needed to Treat (NNT)

3

Common Side Effects:

Dietary restriction challenges: 40%
Potential impact on gut microbiome: 20%
Nutritional inadequacy (if poorly managed): 10%

Annual Cost of Care

Drug Cost

$0

Monitoring

$800

Side Effects

$0

Total Annual

$800

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.2

ICER

$10,000/QALY

Cost per Remission

$2,857

Cost per Responder

$1,667

Treatment Outcomes
Primary Outcomes
IBS Symptom Severity Score (IBS-SSS)300/500 points (moderate-severe IBS)
-27% (-80 points)
Abdominal Pain Severity (VAS)6.5/10 (0=no pain, 10=worst possible pain)
-25% (-1.6 points)
Abdominal Bloating Severity (VAS)6.0/10 (0=no bloating, 10=worst possible bloating)
-28% (-1.7 points)
Bristol Stool Scale (BSS) for IBS-D6.5/7 (average score for loose/watery stools)
-31% (-2.0 points (shift towards normal consistency))
Secondary Benefits
Irritable Bowel Syndrome Quality of Life (IBS-QOL)60/100 points (lower score indicates worse QoL)
+18% (+10.8 points)
Percentage of Weeks with Adequate Relief of IBS Symptoms20% of weeks
+150% (+30 percentage points (e.g., from 20% to 50%))
Fatigue Severity Scale (FSS)5.0/7 (higher score indicates more severe fatigue)
-12% (-0.6 points)
Common Side Effects
Dietary restriction challenges
+40%
Potential impact on gut microbiome
+20%
Nutritional inadequacy (if poorly managed)
+10%

Clinical Trial Phases:

Clinical studies
2
Linaclotide
68% Effectiveness• 90% Confidence• 75% Safety• 26 trials• 10K participants
HIGH EvidenceGood ValueDose: 290 mcg orally once daily (IBS-C) or 145 mcg orally once daily (CIC)
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
75
DangerousModerateSafe

Time to Effect

1-2 weeks

Duration

Long-term (chronic)

Response Rate

35%

Remission Rate

15%

Number Needed to Treat (NNT)

6

Number Needed to Harm (NNH)

5

Common Side Effects:

Diarrhea: 20%
Abdominal pain: 7%
Flatulence: 6%

Annual Cost of Care

Drug Cost

$20,000

Monitoring

$300

Side Effects

$200

Total Annual

$20,500

Cost-Effectiveness

GOOD

QALYs Gained

0.08

ICER

$85,000/QALY

Cost per Remission

$136,667

Cost per Responder

$58,571

Treatment Outcomes
Primary Outcomes
Worst Abdominal Pain Score5.5 on a 0-10 scale
-27% (-1.5 points)
Weekly Complete Spontaneous Bowel Movements (CSBMs)0.8 CSBMs/week
+163% (+1.3 CSBMs/week)
Bristol Stool Scale (BSS) Score1.8 (type 1-2)
+67% (+1.2 points)
Overall Abdominal Discomfort Score6.0 on a 0-10 scale
-30% (-1.8 points)
Secondary Benefits
Abdominal Bloating Score5.0 on a 0-10 scale
-22% (-1.1 points)
IBS-Quality of Life (IBS-QoL) Score45 points (out of 100, lower score indicates worse QoL)
+22% (+10 points)
Straining Severity Score6.5 on a 0-10 scale
-31% (-2.0 points)
Common Side Effects
Diarrhea
+20%
Abdominal pain
+7%
Flatulence
+6%

Clinical Trial Phases:

Phase 3Phase 4
3
Rifaximin
65% Effectiveness• 88% Confidence• 70% Safety• 24 trials• 9K participants
HIGH EvidencePoor ValueDose: 550 mg orally three times daily for 14 days
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
70
DangerousModerateSafe

Time to Effect

1-2 weeks

Duration

14-day course, potentially repeated for recurrence

Response Rate

30%

Remission Rate

10%

Number Needed to Treat (NNT)

8

Number Needed to Harm (NNH)

100

Common Side Effects:

Nausea: 14%
Abdominal pain: 7%
Diarrhea: 5%

Annual Cost of Care

Drug Cost

$18,000

Monitoring

$200

Side Effects

$150

Total Annual

$18,350

Cost-Effectiveness

POOR

QALYs Gained

0.07

ICER

$120,000/QALY

Cost per Remission

$183,500

Cost per Responder

$61,167

Treatment Outcomes
Primary Outcomes
Abdominal Pain Severity (0-10 scale)6.5 points on 0-10 scale
-30.8% (-2.0 points)
Bloating Severity (0-10 scale)6.0 points on 0-10 scale
-25% (-1.5 points)
Bristol Stool Form Scale (BSFS) Score5.5 (loose stool)
-18.2% (-1.0 BSFS point)
IBS Symptom Severity Score (IBS-SSS)350 points (out of 500)
-25.7% (-90 points)
Secondary Benefits
IBS-Quality of Life (IBS-QOL score)60/100
+20% (+12 points)
Number of Days with Abdominal Pain (per month)20 days/month
-25% (-5 days/month)
Frequency of Urgent Bowel Movements (per day)2.5 per day
-40% (-1.0 per day)
Common Side Effects
Nausea
+14%
Abdominal pain
+7%
Diarrhea
+5%

Clinical Trial Phases:

Phase 3Phase 4
4
Eluxadoline
62% Effectiveness• 85% Confidence• 60% Safety• 7 trials• 6K participants
HIGH EvidencePoor ValueDose: 100 mg orally twice daily (or 75 mg twice daily for certain patients)
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

1-2 weeks

Duration

Long-term (chronic)

Response Rate

25%

Remission Rate

8%

Number Needed to Treat (NNT)

9

Number Needed to Harm (NNH)

333

Common Side Effects:

Constipation: 8%
Nausea: 7%
Abdominal pain: 6%
Pancreatitis: 0.3%

Annual Cost of Care

Drug Cost

$15,000

Monitoring

$300

Side Effects

$300

Total Annual

$15,600

Cost-Effectiveness

POOR

QALYs Gained

0.06

ICER

$110,000/QALY

Cost per Remission

$195,000

Cost per Responder

$62,400

Treatment Outcomes
Primary Outcomes
Worst Abdominal Pain Score6.0 (0-10 NRS)
-41.7% (-2.5 points)
Bristol Stool Form Scale (BSFS) Score6.0 (1-7 BSFS)
-30% (-1.8 points)
Stool Urgency Score3.0 (0-4 scale)
-33.3% (-1.0 point)
Secondary Benefits
Daily Bowel Movement Frequency5.0 movements/day
-24% (-1.2 movements/day)
IBS-Quality of Life (IBS-QOL) Score65 (0-100 scale)
+18.5% (+12 points)
Abdominal Bloating Score6.0 (0-10 NRS)
-20% (-1.2 points)
Common Side Effects
Constipation
+8%
Nausea
+7%
Abdominal pain
+6%

Clinical Trial Phases:

Phase 3Phase 4
5
Lubiprostone
60% Effectiveness• 85% Confidence• 75% Safety• 8 trials• 7K participants
HIGH EvidenceModerate ValueDose: 8 mcg orally twice daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
75
DangerousModerateSafe

Time to Effect

1-2 weeks

Duration

Long-term (chronic)

Response Rate

28%

Remission Rate

12%

Number Needed to Treat (NNT)

7

Number Needed to Harm (NNH)

4

Common Side Effects:

Nausea: 23%
Diarrhea: 13%
Abdominal pain: 8%

Annual Cost of Care

Drug Cost

$10,000

Monitoring

$300

Side Effects

$250

Total Annual

$10,550

Cost-Effectiveness

MODERATE

QALYs Gained

0.07

ICER

$100,000/QALY

Cost per Remission

$87,917

Cost per Responder

$37,679

Treatment Outcomes
Primary Outcomes
Global IBS Symptom Severity Score70/100 (higher score indicates worse symptoms)
-21.4% (-15 points)
Abdominal Pain Severity5.5/10 on a 0-10 scale (0=no pain, 10=worst pain)
-18.2% (-1.0 points)
Spontaneous Bowel Movement (SBM) Frequency2.0 SBMs per week
+75% (+1.5 SBMs per week)
Stool Consistency (Bristol Stool Scale)2.0 on Bristol Stool Scale (1-7, 1=hard, 7=liquid)
+50% (+1.0 points)
Secondary Benefits
IBS-Quality of Life (IBS-QOL) Score60/100 on IBS-QOL scale (0-100, higher is better QOL)
+13.3% (+8 points)
Bloating Severity6.0/10 on a 0-10 scale (0=no bloating, 10=worst bloating)
-13.3% (-0.8 points)
Straining Severity7.0/10 on a 0-10 scale (0=no straining, 10=severe straining)
-21.4% (-1.5 points)
Common Side Effects
Nausea
+23%
Diarrhea
+13%
Abdominal pain
+8%

Clinical Trial Phases:

Phase 3Phase 4
6
Tricyclic Antidepressants (TCAs)
55% Effectiveness• 80% Confidence• 60% Safety• 30 trials• 4K participants
MODERATE EvidenceExcellent ValueDose: 10-50 mg orally daily (e.g., Amitriptyline)
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

Long-term (chronic)

Response Rate

40%

Remission Rate

15%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

5

Common Side Effects:

Dry mouth: 25%
Constipation: 20%
Sedation: 15%
Dizziness: 10%

Annual Cost of Care

Drug Cost

$50

Monitoring

$150

Side Effects

$100

Total Annual

$300

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.1

ICER

$10,000/QALY

Cost per Remission

$2,000

Cost per Responder

$750

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+55%
Response Rate
+40%
Remission Rate
+15%
Common Side Effects
Dry mouth
+25%
Constipation
+20%
Sedation
+15%

Clinical Trial Phases:

Phase 4