In this episode of The Good GP, host Dr Krystyna de Lange discusses Irritable Bowel Syndrome (IBS) with Dr Alireza Ahmadvand, a GP, and Professor Gerald Holtmann, a consultant gastroenterologist and director of the gastroenterology and hepatology department at the PA Hospital. This episode is part one of a two-part series exploring IBS from a multidisciplinary approach.

Dr Ahmadvand discusses the differential diagnoses for IBS symptoms in primary care. This includes chronic infections, inflammatory bowel diseases, medication-induced diarrhea, colorectal cancer, and more. They evaluate red flags and initial investigations to distinguish between organic and functional gastrointestinal issues.

Professor Holtmann highlights the importance of understanding patient expectations and provides clarity on diagnosing disorders of gut-brain interaction. He highlights the role of thorough communication and the need to address both the physical symptoms and psychological impact on the patient.

They also delve into the emerging role of the gut microbiome in disorders of gut-brain interaction. Professor Holtmann discusses the relevance of the microbiome composition and the challenges involved in using stool microbiome reports for diagnostic purposes. He elaborates on the potential of targeting the microbiome to improve IBS symptoms through specific treatments, including antibiotics and probiotics.

They conclude with an exploration of pharmacological interventions. Professor Holtmann shares insights on using low-dose tricyclic antidepressants, herbal medicines, and probiotics for IBS management, emphasising the need for balanced treatment strategies that weigh risk and benefit carefully.