Treatment Cycling in IBS-C Drives Greater Healthcare Resource Utilization

Irritable bowel syndrome with constipation (IBS-C) is among the most common diagnoses in gastroenterology practice, and its management is complicated by a crowded therapeutic landscape and persistent patient dissatisfaction.

A new real-world analysis presented at Digestive Disease Week (DDW) 2026 in Chicago, IL, sheds light on a pattern that many clinicians recognize but rarely quantify: the cycle of stopping, restarting, and switching IBS-C medications, and the consequent downstream burden it places on both patients and providers.

“Our question was, with all of the different agents that are out there, what is the journey that patients go on in terms of switching from different agents, one agent to another, stopping or restarting an agent, and do those stops and starts correlate with increased healthcare resource utilization?” study author Kyle Staller, MD, MPH, Massachusetts General Hospital, told HCPLive.

Study Design

The observational analysis drew on nationwide community gastroenterology practice data collected between January 2018 and February 2025, identifying 31,465 adults who had used ≥ 1 IBS-C medication and had a minimum of 365 days of follow-up. Treatment changes including starts, drops, swaps, and add-ons were tracked by medication type and dose. Regression analyses examined associations between patient characteristics, treatment change rates, GI-related healthcare resource utilization (HCRU), and patient portal activity.

Key Findings

Over a mean follow-up of 5.1 years, 41% of patients changed IBS-C treatments at least once. The mean number of treatment changes was approximately 1 per 5 years, but the nature of those changes was striking: roughly 60% were cycles, or patients returning to a previously used medication rather than switching to an agent with a different mechanism of action.

"Many patients are actually doing the same thing over and over again, hoping to get better results the second time," Staller said. "There is a real opportunity to consider alternative treatments when someone has failed one treatment for one reason or another."

“Many patients are actually doing the same thing over and over again, hitting their head against the same wall hoping to get better results, perhaps the second time they do it," Staller said. “I think there is a real opportunity here to consider alternative treatments when someone has failed one treatment for one reason or another.”

Each treatment change was associated with a 9% increase in GI-related HCRU and an 11% increase in patient portal messaging, a finding Staller flagged as particularly relevant given the growing burden of inbox management on gastroenterologists. The top decile of HCRU utilizers averaged > 6 GI-related encounters per year.

Patients with psychiatric comorbidities, somatic pain disorders, and those covered by Medicaid were approximately 20% more likely to have higher treatment change rates. Of note, these same groups are among the highest healthcare utilizers in IBS more broadly.

Clinical Implications

Staller framed the findings as a call to action on two fronts. First, clinicians should be more deliberate about steering patients toward therapeutic alternatives rather than medication restarts when a treatment has already failed. Second, identifying high-risk patients early may allow for targeted interventions that reduce both treatment cycling and its associated resource burden.

"These are the patients that we need to think about targeting with alternative types of treatments," he said. "The reason for a break is probably because of lack of satisfaction with their current treatment options."

Editor's note: Staller reports disclosures with AbbVie, Ardelyx, Gemelli, Salix, and Takeda.

References

1. Scott L, Fossa A, Staller K, et al. Patient Factors Associated With Irritable Bowel Syndrome With Constipation (IBS-C) Treatment Changes. Presented at Digestive Disease Week (DDW) 2026; Chicago, IL; May 2–5, 2026.

2. Brooks A. Despite Advances, IBS Continues to Impact Patients' Daily Lives, Productivity. HCPLive. August 8, 2025. Accessed May 19, 2026. https://www.hcplive.com/view/despite-advances-ibs-continues-to-impact-patients-daily-lives-productivity