Disorder of gut-brain interaction with recurrent abdominal pain related to defaecation and altered stool form/frequency (Rome IV).
Investigations
- • FBC, CRP, coeliac serology, faecal calprotectin
- • Colonoscopy only if alarm features
- • Consider bile acid malabsorption testing in IBS-D
Differential diagnosis
- • IBD
- • Coeliac disease
- • Colorectal cancer
- • Microscopic colitis
- • Bile acid diarrhoea
Management
- • Dietary review; low-FODMAP diet with dietitian
- • Antispasmodics (mebeverine, peppermint oil)
- • Laxatives for IBS-C (avoid lactulose), loperamide for IBS-D
- • Low-dose amitriptyline; CBT/gut-directed hypnotherapy
Clinical pearls
- • Red flags — weight loss, PR bleeding, age >50, nocturnal symptoms — mandate investigation
- • Normal calprotectin makes IBD very unlikely
Related in WardRound
Educational — verify locally.
