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  1. An updated American College of Gastroenterology (ACG) Guideline (2021) for IBS was just published. Among the 25 recommendations for IBS from the ACG are: Serologic testing should be performed to rule out celiac disease in patients with IBS and diarrhea symptoms. Fecal calprotectin, fecal lactoferrin and C-reactive protein should be checked in patients without alarm features and with suspected symptoms of IBS and diarrhea to rule out inflammatory bowel disease Routine stool testing should not be performed for enteric pathogens in all IBS patients. Routine colonoscopy should not be performed in patients with IBS symptoms aged younger than 45 years without warning signs. A positive diagnostic strategy vs. a diagnostic strategy of exclusion should be used for patients with IBS symptoms to improve time to initiate appropriate therapy and cost-effectiveness. Do not test for food allergies and sensitivities unless patients have reproducible symptoms concerning a food allergy. Limited trial of a low fermentable oligosaccharides, disacchardies, monosaccharides, polyols (FODMAP) diet in patients with IBS to improve global symptoms. Anorectal physiology testing should be performed in patients with IBS and symptoms that may suggest a pelvic floor disorder and refractory constipation. Anti-spasmodics available in the United States should be used to treat global IBS. Peppermint may be used to provide relief of global symptoms. Mixed opioid agonists/antagonists should be used to treat global IBS-D symptoms Use of chloride channel activators and guanylate cyclase activators (Linzess / Constella) to treat global IBS with constipation symptoms. Use of rifaximin (Xifaxan) to treat global IBS with diarrhea symptoms. Gut-directed psychotherapy (CBT) be used to treat global IBS symptoms. Source(s): Healio Pubmed: PMID: 33315591
  2. Mistakes in irritable bowel syndrome and how to avoid them September 21, 2016 | By: Robin Spiller View complete version Around 11% of the worldwide population experience irritable bowel syndrome (IBS), making it one of the most frequent gastroenterological diagnoses.1 The symptoms of IBS include abdominal pain associated with unpredictable bowel habits and variable changes in the form and frequency of stool.2 While all patients with IBS suffer from recurrent bouts of abdominal pain, their bowel habits are varied: around one-third suffer predominantly with diarrhoea (IBS-D), one-fifth experience predominantly constipation (IBS-C) and half have an erratic mixed pattern of both diarrhoea and constipation (IBS-M).3This very heterogeneous condition undoubtedly has multiple causes and an individualized approach to management and treatment is required. Here I discuss the mistakes most frequently made when diagnosing and managing IBS. The mistakes and discussion that follow are based, where possible, on published data and failing that on many years of my own clinical experience. Mistake 1 | Failing to detect bile salt malabsorption Mistake 2 | Failing to recognize somatization, leading to multiple referrals to non-gastrointestinal specialists Mistake 3 | Not telling the patient that they have a high probability of having IBS at the onset of investigation Mistake 4 | Failing to recognize the key features of bloating, leading to multiple negative investigations including CT and ultrasound Mistake 5 | Using opiates to control IBS pain Mistake 6 | Misdiagnosing Crohn’s disease as IBS-D Mistake 7 | Performing cholecystectomy for right upper quadrant pain without gallstones Mistake 8 | Performing a hysterectomy/laparoscopy and division of adhesions for IBS pain Mistake 9 | Testing for lactose intolerance when a patient consumes <240ml of milk or its equivalent per day Mistake 10 | Encouraging food exclusion without reinforcing the need to reintroduce foods to confirm apparent intolerance, leading to ever more restricted diets and malnutrition © UEG 2016 Spiller. Reference: Spiller R. Mistakes in irritable bowel syndrome and how to avoid them. UEG Education 2016: 16; 31–33.
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