Fiber and Dietary Therapies
Food elimination diets based on immunoglobulin G (IgG) antibodies are not recommended, nor are gluten-free diets.
Soluble fiber is effective for global symptoms and abdominal pain, but insoluble fiber should be avoided.
A diet low in fermentable oligosaccharides, disaccharides, and monosaccharides and polyols is effective second-line therapy for global symptoms and abdominal pain.
Probiotics may be effective for global symptoms and abdominal pain, but no specific species or strain can be recommended.
First-Line Drugs for IBS
Loperamide may be effective for diarrhea. Peppermint oil and certain antispasmodics may be effective for global symptoms and abdominal pain. Polyethylene glycol may be effective for constipation.
Tricyclic antidepressants (TCAs) used as gut-brain neuromodulators are effective second-line treatment for global symptoms and abdominal pain. Selective serotonin reuptake inhibitors (SSRIs) used as gut-brain neuromodulators may be effective second-line treatment for global symptoms.
Second-Line Drugs in Secondary Care
Eluxadoline, 5-hydroxytryptamine 3 (5-HT3) receptor antagonists, and rifaximin are efficacious second-line drugs for IBS with diarrhea (IBS-D) in secondary care. Linaclotide, lubiprostone, plecanatide, tenapanor, and tegaserod are efficacious second-line agents for IBS with constipation (IBS-C) in secondary care.
IBS-specific cognitive behavioral therapy (CBT) and gut-directed hypnotherapy may be efficacious for global symptoms.
Severe or Refractory Symptoms
Severe or refractory IBS should be managed with an integrated multidisciplinary approach, with care taken to avoid iatrogenic harms.
Combination gut-brain neuromodulators (augmentation) may be considered for more severe symptoms.
For more information, please go to Irritable Bowel Syndrome (IBS).
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Cite this: Management of Irritable Bowel Syndrome (IBS) Clinical Practice Guidelines (BSG, 2021) - Medscape - Aug 06, 2021.