IBS

Question 1

Simple management for IBS?

Answer 1

1. Low FODMAP diet (70% response)
2. Medications: buscopan or mebeverine for spasms - mebeverine fewer SE (and OTC) but both safe; linseed or isaphagula husks if constipation (+/- stool softeners)
3. Probiotics - could recommend
4. Psychological support (about 50% will have anxiety/depression, or if also has chronic fatigue, fibromyalgia) - important to treat stress/anxiety as it is a big driver and otherwise other treatments won’t help

Question 2

Three probiotics in UK to reduce bloating and flatulence

Answer 2

Symprove; VSL-3; Vivomixx - tested in controlled trials (unlike others) showing 20% improvement from placebo, but more expensive. Try for 2-4 weeks. Helpful for bloating (not so much for frequency)

Question 3

What other psychotherapy could be tried for IBS?

Answer 3

Hypnotherapy could be helpful

Question 4

Which anti-anxiety/depressive medications are used in IBS?

Answer 4

Citalopram for depression; amitriptyline for IBS-D