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A guideline on assessing and managing irritable bowel syndrome has been produced by the British Society of Gastroenterology after a systematic literature search, internal and external review (including from patients), and achievement of consensus.
It recommends categorisation by bowel habit, few investigations, being alert to alarm features, and attention to patients' concerns, including psychological features. Trials are stated to have shown that benefit is gained from cognitive behaviour therapy and psychodynamic interpersonal therapy, which help patients to cope; antispasmodics and tricyclics, which may help pain; and ispaghula, which relieves pain and improves bowel habit. Other major benefits are shown to come from 5-HT3 antagonists, 5-HT4 agonists, and selective serotonin reuptake inhibitors. Ten suggestions are made for future research, in particular the need to identify which patients are likely to respond to specific treatments.