IBS - Mixed


Rule out celiac disease.

Rule out h. pylori for dyspepsia.

Improved bowel movements with constipation and diarrhea.

Citrucel fiber supplementation. (over the counter)

High fiber diet.

Miralax supplementation for constipation.

Can try Ginger root for abdominal pain (over the counter)

Can try peppermint oil for cramping (over the counter)

It is reasonable to try probiotics (over the counter)

It is reasonable to try probiotic yogurts.

Bentyl for anti-spasmodic features.

Low FODMAP diet ( Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. These are complex names for a collection of molecules found in food, that can be poorly absorbed by some people.) 

Start a food/sleep/stress/pain/bowel movement diary to identify triggers.

Dairy and gluten can be sensitive foods for patients to avoid.

Can f/u with psychology for stress management/anxiety.  PCM to monitor.

Avoid narcotics, nsaids, and BZDs

Consider 2nd line treatments

TCA trial

SIBO (small intestine bacterial overgrowth) treatment

# IBS { with constipation | with diarrhea | mixed }

-- Exercise

-- Probiotics

-- Consider peppermint oil

-- Consider antibiotic treatment

-- Antispasmotics: bentyl

-- Antidepressants //SSRIs used in these trials included citalopram, fluoxetine, and paroxetine, and tricyclic antidepressants included amitriptyline, desipramine, and imipramine.  

-- No evidence for Buspirone, clonazepam, divalproex sodium, or risperidone 

-- Referral for psychological counseling

-- Fiber is ineffective (SOR A)

//Ref: Wilkins T, Pepitone C, Alex B, Schade RR: Diagnosis and management of IBS in adults. Am Fam Physician 2012;86(5):419-426.