A Study of Virtual Reality and Linaclotide for IBS-C

The primary aim of this study will be to assess the benefits of disease-targeted VR combined with linaclotide, compared to sham VR combined with linaclotide, in patients with IBS-C as defined by Rome IV criteria. The investigators hypothesize that compared to patients receiving sham VR and linaclotide, IBS-C patients receiving combination therapy with active VR and linaclotide will achieve statistically significant and clinically meaningful improvements in disease-targeted health-related quality of life while demonstrating improvements in global IBS symptoms, including abdominal pain.

Aims

• Evaluate changes in quality of life using the validated IBS-QoL (primary outcome);
• Evaluate global improvement in IBS symptoms using the validated IBS-SSS;
• Assess global improvement in IBS symptoms using the validated Abdominal Scoring system (11);
• Evaluate improvement in abdominal pain using a numerical rating system (NRS);
• Assess improvement in constipation using the Bristol Stool Form Scale (BSFS);
• Evaluate response to bloating using the validated Mayo bloating questionnaire (12);
• Assess response to coexisting psychological distress using the validated HADs questionnaire;
• Evaluate changes in work productivity using the validated WPAI.

Inclusion criteria

• Adult men and women (18-70) who meet Rome IV criteria for IBS-C.
• Patients will be required to score below 65 points on the IBS Quality of Life (IBS-QOL) instrument, indicating a score consistent with at least moderate HRQOL (Health-related quality of life) impairment.

Exclusion criteria

• Patients will be excluded from the study if they have a comorbid disorder that may confound the diagnosis of IBS, including celiac disease, inflammatory bowel disease, autoimmune disorders that affect the GI system, history of bowel resection, HIV/AIDS, diabetes with HgA1c >7.0, neuroendocrine tumors, microscopic colitis, lactase deficiency, eosinophilic bowel disease, acute intermittent porphyria, or any other condition that a licensed physician believes can mimic IBS symptoms and undermine diagnostic certitude.
• Patients with severe depression, defined as a score equal to or greater than two standard deviations (SDs) on the NIH PROMIS depression scale, or those with suicidal ideations, will also be excluded and provided with standard resources to support their mental health and referred back to their primary care provider, a member of the study team will follow up with the PCP to ensure the communication was received.
• Patients using regular doses of opioid medications will also be excluded given the often-severe impact of opioids on GI motility and potential for pharmacological visceral hyperalgesia.
• Patients will also be excluded from the study if they do not meet Rome IV criteria for IBS-C,
• have a known seizure disorder,
• if symptoms are thought to represent an organic disorder,
• if they have had prior surgery to the colon,
• if symptoms represent a known pelvic floor disorder,
• if the patient is abusing alcohol,
• or if the patient cannot actively participate in the study for any other reason (e.g., inability to understand English as the VR program is in English only).
• Patients previously treated with linaclotide who reported side effects,
• those currently on linaclotide (any dose),
• and those who did not note an improvement in IBS-C symptoms in the past while on linaclotide will also be excluded.