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Management of Irritable Bowel Syndrome (IBS)

Diagnostic testing for IBS:

  • Testing should be done to rule out celiac disease, in particular in patients with IBS and diarrhea symptoms.
  • Patients should be advised to eliminate dairy products (milk, cheese, yogurt, butter, ice cream) for one month to assess lactose intolerance and dairy intolerance.
  • Stool testing for fecal calprotectin should be ordered to rule out inflammatory bowel diseases such as Crohn’s Disease and Ulcerative Colitis. 
  • Blood testing such as ESR and CRP should be done to rule out systemic inflammation, which points to inflammatory bowel disease. 
  • Routine stool testing is not recommended to rule out infections such as E. coli, Salmonella, Shigella, parasites, etc…
  • Routine colonoscopy is not recommended in patients younger than 45 years of age without warning signs (sudden changes in bowel habits, blood in the stool, abdominal pain, unintentional weight loss)
  • Testing for food allergies and food sensitivities is not recommended in all IBS patients. 
  • Anorectal physiology testing should be performed in patients with IBS and symptoms suggesting pelvic floor disorder and/or refractory constipation not responding to standard medical therapy. 

more treatment recommendations:

  • Limited trial of a FODMAP diet (6 weeks) to temporarily improve symptoms (low quality of evidence) 

  • Use medicines that activate the 5-HT receptors in women younger than 65 with low cardiovascular risk factors to treat IBS-C.

  • Avoid bile-acid sequestrant medicines in patients with IBS-D

    Alosteron can be used to relieve symptoms of IBS-D with severe symptoms who have failed conventional therapy 

    Tricyclic antidepressants should be used to treat symptoms of IBS (strong recommendation)

    Avoid bile-acid sequestrant medicines in patients with IBS-D

    Gut-directed psychotherapy should be used to treat IBS symptoms (strong recommendation)

    Fecal transplant should be avoided in patients with IBS