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IBS self-care — GPhC CRA MCQ

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HardGastro-intestinal TherapeuticsIBS self-careGPhC CRA

A 34-year-old with constipation-predominant irritable bowel syndrome has increased wheat-bran intake and started lactulose. Bloating and abdominal pain have worsened, although there are no alarm features. Which adjustment best reflects NICE advice?

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Correct answer: A — Reduce bran, stop lactulose and trial ispaghula cautiously

In IBS, insoluble fibre such as bran may worsen pain and bloating. If fibre is increased, soluble fibre such as ispaghula or oats is preferred and titrated gradually. Laxatives may be considered for constipation, but NICE discourages lactulose because it commonly worsens bloating. The adjustment therefore removes both likely aggravating factors while cautiously introducing soluble fibre.

Reference: NICE CG61: Irritable bowel syndrome in adults: https://www.nice.org.uk/guidance/cg61/chapter/recommendations