Irritable bowel syndrome is common and can have a considerable impact on quality of life. Early diagnosis and timely and evidence based management is key to improved outcomes and best management. Consideration of the differential diagnosis is important. Christopher Black and Alexander Ford have previously written for us on rational and appropriate investigation.1 In this issue the authors cover ‘Best Management’. Multiple different treatment options are discussed including anti-spasmodics, peppermint oil, neuromodulators and tricyclics. There is a strong focus on good communication and holistic care and setting realistic expectations of treatment. Simple lifestyle and dietary strategies are important. A low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) can be considered providing dietetic support is available. Patients with constipation resistant to laxatives should be offered a trial of linaclotide. For patients with diarrhoea that fails to respond to loperamide alosetron and ramosetron can be considered. For patients who are symptomatic with significant impact on their functioning cognitive behavioural therapy and gut directed hypnotherapy should be considered both of whom have a reasonable evidence base. Refractory IBS can be very challenging. This is an excellent review of the best available treatment options – evidence based, focused and practical for implementation by the busy clinician. Listen to the linked Podcast. Editor’s Choice this month (See page 303) . Iron deficiency anaemia is common in gastroenterological disorders including inflammatory bowel disease although not always straightforward to treat particularly in the context of …

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本期亮点

肠易激综合征很常见，会对生活质量产生相当大的影响。早期诊断和及时循证管理是改善结果和最佳管理的关键。考虑鉴别诊断很重要。Christopher Black 和 Alexander Ford 之前为我们撰写了关于理性和适当调查的文章。1 在本期中，作者涵盖了“最佳管理”。讨论了多种不同的治疗方案，包括抗痉挛药、薄荷油、神经调节剂和三环类药物。非常注重良好的沟通和整体护理，并设定切合实际的治疗期望。简单的生活方式和饮食策略很重要。可以考虑使用低 FODMAP（可发酵的低聚糖、二糖、单糖和多元醇）提供饮食支持。对泻药有抵抗力的便秘患者应试用利那洛肽。对于对洛哌丁胺阿洛司琼和雷莫司琼无反应的腹泻患者，可以考虑。对于有症状且对其功能性认知行为疗法和肠道定向催眠疗法有显着影响的患者，应考虑两者都有合理的证据基础。难治性 IBS 可能非常具有挑战性。这是对最佳可用治疗方案的精彩回顾——基于证据、重点突出且实用，可供忙碌的临床医生实施。收听链接的播客。本月的编辑选择（见第 303 页）。缺铁性贫血在胃肠道疾病中很常见，包括炎症性肠病，但并不总是很容易治疗，特别是在……