Linaclotide for irritable bowel syndrome with constipation: integrating realworld evidence into the therapeutic puzzle

Irritable bowel syndrome with constipation (IBS-C) is a common subtype of functional bowel disorder associated with substantial symptom burden and reduced quality of life. Management typically begins with dietary and lifestyle modification, laxatives, and antispasmodics; however, many patients experience inadequate relief, underscoring the need for more effective therapies. Linaclotide, a synthetic guanylin analog, is an established treatment for IBS-C. By activating guanylate cyclase-C (GCC) receptors on intestinal epithelial cells, it promotes intestinal fluid secretion, accelerates transit, and alleviates visceral hypersensitivity. Randomized controlled trials have demonstrated its efficacy and favorable safety profile, with mild-to-moderate diarrhea and abdominal pain being the most common adverse events. Because clinical trial populations may not fully reflect real-world patient diversity, real-world evidence (RWE) provides valuable complementary data. This review summarizes current RWE on linaclotide in IBS-C, integrating findings from multiple studies to present a comprehensive view of its effectiveness and safety in routine clinical practice.