Clinical management

Amitriptyline an effective second line treatment for IBS

A trial across 55 general practices in England aimed to determine the effectiveness of amitriptyline as a second-line treatment for irritable bowel syndrome (IBS).
463 participants were randomly allocated to receive low-dose amitriptyline (10mg, with dose titration up to 30mg over 3 weeks) or placebo for 6 months. The IBS Severity Scoring System (IBS-SSS) was used to assess response to amitriptyline compared to placebo.
There was a significant improvement in the IBS-SSS after 6 months treatment with amitriptyline compared to placebo.

For people with IBS who don’t improve with first line therapies, offer low-dose amitriptyline. See a leaflet on the rationale for using amitriptyline and a dose titration document co-developed with patients here: https://ctru.leeds.ac.uk/atlantis/
Reflect on your clinical management of IBS cases and whether you discuss the brain-gut axis and explore/ support the management of psychological comorbidities.
Consider signposting patients to the IBS self-care programme- perhaps you could add this link to an automated text message at your practice?
https://www.theibsnetwork.org/the-self-care-programme/