• IBS: Clinical Diagnosis, consider celiac tests, further work up only if alarm symptoms are present 
    • Diet (FODMAP) i.e Diet low in ; Education, Exercise, and Reassurance; Ispaghula
      • Fermentable Oligosach (wheat, barley, onion, garlic, casews), Disach (Lactose), Monosacch (Free Fructose i.e Fruits), And Polyols (Sorbitol, Mannitol, Xylitol) 
    • Constipation Predominant: Osmotic laxatives (PEG) , Lubiprostone (Amitiza; Chloride Channel Activator), Guanylate Cyclase agonist (Linaclotide), 5HT 4 agonist (Tegaserod)
    • Diarrhea Predominant: Antidiarrheal agent (RCT evaluated - Loperamide, 2 mg 45 min before meal); Others: Bile acid sequester ant i.e Cholesevelam (Welchol), Cholestyrmine, Colestipol, 5HT3 antagonist (Alosetron only for F with severe IBS-D)
    • Mixed
    • PainAntispasmodic i.e Dicyclomine (Bentyl), Hyoscyamine; 

Irritable Bowel Syndrome JAMA 2015                                                         IBS BMJ 2013