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IBS constipation management — GPhC CRA MCQ

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ModerateGI TherapeuticsIBS constipation managementGPhC CRA

A 52-year-old woman with irritable bowel syndrome (IBS) predominantly with constipation asks for advice on managing her symptoms. She has tried increasing fibre and fluid intake. What is the most appropriate pharmacological recommendation?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Ispaghula husk one sachet daily, adjusted according to response

NICE recommends ispaghula husk (a soluble fibre supplement) as the first-line pharmacological option for IBS with constipation, as it adds bulk and softens stools without the bloating associated with insoluble fibre such as bran. Lactulose is not recommended in IBS as it can worsen bloating. Stimulant laxatives should be used with caution. Loperamide and codeine would worsen constipation and are more appropriate for diarrhoea-predominant IBS.

Reference: NICE CG61 IBS; BNF