Several of the most common treatments for irritable bowel syndrome could raise the risk of death, a study suggests.
Irritable bowel syndrome (IBS) is a gastrointestinal disorder that causes a range of symptoms such as abdominal pain, bloating, diarrhea and constipation.
Affecting up to one in 10 Americans, the condition has no cure but can be managed with dietary modifications, behavioral therapy and medications such as laxatives, fiber supplements, probiotics and low doses of certain antidepressants.
However, researchers at Cedars-Sinai Health Sciences University in Los Angeles have suggested medications for IBS may carry long-term, unforeseen consequences.
Combing through two decades’ worth of health records from 650,000 Americans, the team assessed FDA approved IBS medications, along with antidepressants, muscle relaxants and anti-diarrheal drugs.
They found that long-term antidepressant use was associated with a 35 percent higher risk of death compared to patients not taking those medications.
Additionally, the diarrhea opioid diphenoxylate was associated with an 89 percent increased risk of death, and long-term use of over-the-counter diarrhea medication loperamide (sold under brand names like Imodium) was linked to double the risk of death from any cause compared to not taking the drug.
The study authors caution that the findings do not prove these medications directly cause death, but the results could mean the medications were associated with higher rates of adverse side effects like heart attack, falls and stroke.
A new study suggests some medications commonly used to treat IBS are associated with an increased risk of death (stock image)
‘Many patients are diagnosed with IBS at a young age and may remain on medications for years,’ Dr Ali Rezaie, senior study author and medical director of the GI Motility Program at Cedars-Sinai, said.
‘However, most clinical trials of these medications last less than a year, so we know very little about their long-term safety. This study begins to address that gap.’
Rezaie also cautioned that IBS patients ‘should not panic, but they do need to understand and weigh the small but meaningful risks when considering long-term treatments.’
‘Patients should speak with their healthcare provider about the safest and most effective options for managing their symptoms.’
The study, published in the journal Communications Medicine, looked at electronic health data from 2005 to 2023 including 669,083 US adults who had been diagnosed with IBS.
Of the participants, 52 percent were on antidepressants and 22 percent were on antispasmodics, which include muscle relaxers.
Selective serotonin reuptake inhibitors (SSRIs) included in the study were citalopram (Celexa), sertraline (Zoloft), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox) and paroxetine (Paxil).
Other antidepressants included in the study that can be used for IBS symptom management included amitriptyline, nortriptyline and duloxetine.
The researchers found IBS patients taking antidepressants had a 35 percent higher risk of all-cause mortality compared to patients not taking these drugs.
Patients specifically on SSRIs were at a 32 percent increased risk, while those on older classes of antidepressants such as tricyclics and serotonin and norepinephrine reuptake inhibitors (SNRIs) were at a 27 percent and 32 percent increased risk, respectively.
Patients on the tetracyclic antidepressant mirtazapine, which is also used to treat major depressive disorder, were also twice as likely to die from any cause compared to non-users.
Antidepressants were associated with a higher risk of death, which could be due to heart-related side effects and weight gain (stock image)
The researchers also evaluated the anti-diarrheal opioid diphenoxylate, which is only available with a prescription, and loperamide, an over-the-counter anti-diarrheal.
They found diphenoxylate was associated with an 89 percent increased risk of death, while loperamide elevated the chance by 2.3-fold compared to IBS patients not taking the drug.
The experts noted that antidepressants in particular have increasingly been linked to irregular heart rhythms, heart attacks and stroke, as they may alter the heart’s electrical system and increase levels of serotonin, which can cause blood vessels to constrict and blood pressure to increase.
Antidepressant use has also been linked to lung infections such as pneumonia by compromising airway protection, along with weight gain, which increases the likelihood of a heart attack or stroke.
Additionally, the team said loperamide ‘is suspected to block sodium and potassium channels’ in the heart’s myocardium, potentially leading to arrhythmias.
Rezaie said more research is needed to confirm the results and identify which patients may be at greatest risk of adverse consequences. He is urging doctors to focus on more individualized treatments for IBS patients.
‘Treatment for IBS patients should focus on identifying the underlying causes and using the safest, evidence-based options available rather than relying on a single class of medications for long-term management,’ he said.
