IBS

I often wonder if patients have IBS, so was quite pleased to find the official IBS diagnosis criteria, and the NICE guidelines.

Diagnosis
Using a combination of NICE guidelines and Rome III guidelines, consider assessment for IBS if you have any of the following symptoms:
- Abdominal pain or discomfort (at least 3 days/month in the last 3 months)
- Bloating
- Change in bowel habit - change in frequency or form of stool

Treatment
Increase soluble fibre (eg oats)
Reduce insoluble fibre (eg wholemeal and high-bran cereals)

Laxatives
Lactulose is not recommended.
Osmotic laxatives such as magnesium hydroxide (milk of magnesia) or macrogol (polyethylene glycol; Movicol®) may be recommended.
Stimulants not recommended
Bulk-forming laxatives (ispaghula husk, methylcellulose, sterculia)

Painkillers
Mebeverine hydrochloride (Colofac®) or alverine citrate (Spasmonal®)
Peppermint oil

Antimuscarinics (anticholinergics) such as hyoscine butylbromide (Buscopan®) are poorly selective and are likely to cause antimuscarinic adverse effects.