Date of Award


Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)


Physician Assistant Studies

First Advisor

Andvik, Vicki


irritable bowel syndrome, tricyclic antidepressants, low FODMAP diet, diet modification, visceral manipulation


Irritable bowel syndrome (IBS) is a disorder of the gut-brain interaction that is a chronic and often debilitating disorder characterized by symptoms of recurrent abdominal pain and disordered defecation, affecting up to 10-12% of adults in North America. The purpose of this study analysis is to compare tricyclic antidepressant (TCA) use to diet modification and visceral manipulation in the treatment of IBS. A literature review was performed using various health science databases such as, PubMed, Google Scholar and ClinicalKey, within a time frame of 20 years. Studies chosen for review were peer reviewed and focused on randomized control trials. Several studies were excluded, as they investigated the use of antispasmodics as well as laxative use and bulking agents. Ten studies met the final criteria. The research shows evidence of reduced IBS symptoms with the use of tricyclic antidepressants, diet modification and visceral manipulation. Diet modification appears to be the most beneficial with the least amount of side effects when compared to TCA use, however, more research needs to be done to evaluate how patients react to reintroduction of foods with elimination diets. Visceral manipulation appears to help with refractory symptoms, but more studies need to be conducted in this area due to the increased usage of this option as a treatment for IBS. Tricyclic antidepressants are currently one of the most effective medications for overall symptom improvement, however, more side effects are seen with this treatment option due to anticholinergic effects of these medications. Due to the multifactorial process of IBS, a combination of treatment options is likely to benefit patients more than a single approach alone, to adequately treat patient symptoms.