Table 3.

Treatment of IBS based on IBS subtype.

	IBS-M or IBS-U	IBS-C	IBS-D
First-line treatments	* Antispasmodic (e.g., hyoscine, peppermint oil)	* Laxative	* Loperamide
Second-line treatments	** Gut-brain neuromodulator (e.g., TCA or SSRI)	* Secretagogue or 5-HT4 agonist	* 5-HT3 receptor antagonist, eluxadoline, rifaximin
Psychological therapies	IBS-specific cognitive behavioral therapy or gut-directed hypnotherapy, if available

* Continue for 3 months and discontinue if no response. ** TCAs should be the first choice and the treatment should be continued for at least 6 months in case of symptomatic response. TCA, tricyclic antidepressant; SSRI, selective serotonin reuptake inhibitor; 5-HT, 5-hydroxytryptamine; IBS-M, IBS with a mixed pattern; IBS-U, IBS unclassified; IBS-C, IBS with constipation; IBS-D, IBS with diarrhea.