Management of Irritable Bowel Syndrome and Ulcerative Colitis

First-Line Treatments for IBS

The American Gastroenterological Association recommends regular exercise for all IBS patients, as it can help improve symptoms 1, 2
First-line dietary advice should include increasing soluble fiber intake, such as ispaghula, starting at low doses (3-4g/day) and gradually increasing to avoid bloating, as recommended by the National Institute for Health and Care Excellence 1, 3
The European Society for Neurogastroenterology and Motility suggests that a low FODMAP diet may be considered as second-line dietary therapy under the supervision of a trained dietitian 1, 2
The American College of Gastroenterology recommends that gluten-free diets are not recommended unless there is evidence of celiac disease 3, 2
Probiotics may be effective for global symptoms and abdominal pain in IBS patients, with a recommended 12-week trial, as suggested by the World Gastroenterology Organisation 1, 4

The American Gastroenterological Association recommends tricyclic antidepressants (TCAs) as effective second-line drugs for global symptoms and abdominal pain in IBS patients, starting at low dose (10mg amitriptyline once daily) and titrating slowly to 30-50mg once daily 3, 2
The European Society for Neurogastroenterology and Motility suggests that 5-HT3 receptor antagonists are highly efficacious second-line drugs for IBS with diarrhea 3, 2
Rifaximin (non-absorbable antibiotic) is effective for IBS with diarrhea, though its effect on abdominal pain is limited, as recommended by the American College of Gastroenterology 3, 5

The American Gastroenterological Association recommends that treatment for active UC typically involves anti-inflammatory medications, including 5-aminosalicylates (5-ASAs) for mild to moderate disease, corticosteroids for moderate to severe flares, and immunomodulators for maintenance therapy 5
The European Crohn’s and Colitis Organisation suggests that biologics (anti-TNF agents, anti-integrins, JAK inhibitors) may be effective for moderate to severe UC or steroid-dependent cases 5

The American Gastroenterological Association recommends that tricyclic antidepressants have shown benefit for functional GI symptoms in IBD patients 5
The American College of Gastroenterology suggests that rifaximin may be beneficial in IBD patients with small intestinal bacterial overgrowth (SIBO) 5

The National Institute for Health and Care Excellence recommends establishing a positive diagnosis and explaining the nature of IBS/UC to patients, and recognizing IBS as a disorder of gut-brain interaction requiring explanation of the gut-brain axis to patients 4, 2
The American Gastroenterological Association suggests that symptoms may relapse and remit over time, requiring periodic adjustment of treatment strategy, and that opiates should be avoided for chronic pain management in both IBS and IBD 2, 5