Diagnosis

• Confirming a diagnosis of IBS is a crucial part of this guideline. The primary aim should be to establish the person’s symptom profile
• Consider IBS if:
  • Abdominal pain
  • Bloating
  • Change in Bowel habit
• RED FLAGs: rectal bleeding, weight loss, change in bowel habit looser more frequent, Fx Ca, rectal or abdominal masses (test for CA-125), anaemia
• Diagnose IBS if abdominal pain relived by defecation OR a/w altered bowel habit PLUS two of:
  • Abdominal bloating
  • Altered stool passage
  • Passage of mucus
  • Made worse by eating

Investigation

• Should be undertaken to rule out other cause:
  • Antibody testing for Coeliac disease
  • FBC
  • ESR / CRP
• The following are not necessary to confirm diagnosis:
  • USS
  • Flexi-sig
  • Colonoscopy
  • TFT
  • Faecal occult blood
  • Ova
  • Parasite
  • H2 breath test (overgrowth)

Management

Dietary and Lifestyle

• Regular meals, avoid missing meals
• 8 cups of fluid / day, but restrict caffeine and tea to 3 cups
• Reduce alcohol and fizzy drinks
• Limit intake of high fibre food: especially if constipated
• Limit fresh fruit to 3 portions a day: especially if have diarrhoea
• Avoid sorbitol (artificial sweetener) if have diarrhoea
• Add oats and linseed (soluble fibre)
• Pro-biotics: take for 4 weeks and monitor impact
• If symptoms persist specialist dietician should supervise:
  • Single food avoidance diets
  • Low FODMAP foods: fermentable sugars e.g. apples, pears, onions

Pharmacological Therapy

• Anti-spasmodic agents
• Laxatives: constipation, titrated to symptoms
• Loperamide: diarrhoea
• If ineffective: Tri-Cyclic anti-depressants low dose or SSRIs
• If in effective after 12 months consider CBT

NICE Source: CG61 Irritable bowel syndrome in adults: diagnosis and management. Summary compiled by Dr D P Sheppard MBBS.