Management of Irritable Bowel Syndrome (IBS)

According to: American College of Gastroenterology Guidelines

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.

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