IBS When a Gut-Brain Neuromodulator Has Not Improved Symptoms
This protocol defines the recommended clinical step for irritable bowel syndrome after a course of gut-brain neuromodulator therapy has not produced an adequate response.
Previous Treatment — Insufficient Response
A gut-brain neuromodulator — a tricyclic antidepressant or, alternatively, a selective serotonin reuptake inhibitor — did not achieve the target of improvement in global IBS symptoms and abdominal pain. This protocol specifies the next structured step after that failure.
Next-Line Approach (partial overview)
The approach at this stage involves a form of psychological therapy specifically directed at IBS.
The full protocol — specific modalities, decision pathway, and clinical considerations — is available via the link below.
Clinical Goal
Improvement in global IBS symptoms.
References
DOI: 10.1136/gutjnl-2021-324598
IBS-specific cognitive behavioural therapy may be an efficacious treatment for global symptoms in IBS (recommendation: strong, quality of evidence: low).
Gut-directed hypnotherapy may be an efficacious treatment for global symptoms in IBS (recommendation: strong, quality of evidence: low).
Psychological therapies should be considered when symptoms have not improved after 12 months of drug treatment. Referral can be made at an earlier stage, if accessible locally, and based on patient preference (recommendation: strong, quality of evidence: low).
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