Table 7 Suggested sequence of pharmacological treatment for irritable bowel syndrome
Predominant symptomFirst lineSecond line
PainAntispasmodicTricyclic antidepressives
Psychological treatments
DiarrhoeaLoperamide5-HT3 antagonist*
ConstipationIspaghula5-HT4 agonist*
Bloating with distensionDietary manipulationProbiotics
Polyethylene glycols5-HT4 agonist*
Bloating withoutAntispasmodic agentsProbiotics
  • *No representative of this class of drugs is currently licensed for IBS in Europe but there are other related drugs in development.