Severe IBS When Psychological Therapy Has Not Achieved Global Symptom Improvement
When IBS-specific cognitive behavioural therapy or gut-directed hypnotherapy has been completed without achieving meaningful improvement in global IBS symptoms, a structured next-line approach is warranted for patients with persistent, severe symptoms.
Prior therapy: Psychological therapy — IBS-specific cognitive behavioural therapy or gut-directed hypnotherapy.
Unmet goal: Improvement in global IBS symptoms was not achieved, indicating escalation to this protocol.
Management at this stage draws on a combination approach involving gut-brain neuromodulators in an augmentation strategy, delivered within an integrated multidisciplinary framework. The complete regimen, sequencing, and clinical safety considerations are available in the full protocol.
Treatment goal: Improvement in severe IBS symptoms.
References
Use of combination gut-brain neuromodulators, termed augmentation, may be considered for more severe symptoms, with vigilance for risks of serotonin syndrome (recommendation: weak, evidence: very low).
Severe or refractory IBS should be managed with an integrated multi-disciplinary approach (recommendation: weak, evidence: very low).
DOI: 10.1136/gutjnl-2021-324598
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