This is an update to the 2008 guideline on IBS from NICE. Most of it is same; I have listed the changes.
Most advice is the same. However, for people with symptoms not responding to other treatments, NICE advises that single item dietary exclusion could be tried. This includes the FODMAP diet (fermentable oligosaccharides, disaccharides, monosaccharides and polyols). This latter should be initiated by a dietician. This advice has been included because of the popularity of the diet. There is very low quality evidence of benefit to abdominal symptoms, pain and bloating. There is some very low quality evidence of benefit for flatulence (but some showing no benefit). There is no evidence of benefit to diarrhoea or constipation.
Linaclotide can be tried if
- laxatives from other classes at maximum tolerated or optimal doses have been tried AND
- they've had constipation for at least 12 months.
Patients should be reassessed after 3 months.
- Tricyclic antidepressants (TCAs) can be considered if laxatives, antispasmodics and loperamide haven't helped. Start with a low dose and build up. Doses above 30mg are rarely needed.
- SSRIs can be tried if TCAs aren't helpful.