Irritable bowel syndrome — structured viva

Structured oral on irritable bowel syndrome: defending the positive Rome IV diagnosis with limited testing, arguing subtype-based therapy from trial evidence, staging the low-FODMAP diet safely, deploying gut-brain therapies, and framing benign prognosis without dismissing the patient.

Prompt

The examiner opens: 'Your predecessor colonoscoped every IBS patient. Your registrar wants to FODMAP everyone. Defend your pathway.' The viva branches through positive diagnosis, the limited battery, subtype therapy, diet, gut-brain interventions, and prognosis.

Stem

You are the GP. Two extremes compete for your IBS pathway: scope everything, or FODMAP everything. ^[18]

References13Show

[2]Menees SB, Powell C, Kurlander J et al. A meta-analysis of the utility of C-reactive protein, erythrocyte sedimentation rate, fecal calprotectin, and fecal lactoferrin to exclude inflammatory bowel disease in adults with IBS. The American journal of gastroenterology, 2015.PMID 25732419
[4]Staudacher HM, Rucco V, Mancell S et al. Fiber supplementation in irritable bowel syndrome: a systematic review and meta-analysis of randomized controlled trials. Gastroenterology, 2026.PMID 42600900
[6]Ford AC, Wright-Hughes A, Alderson SL et al. Amitriptyline at Low-Dose and Titrated for Irritable Bowel Syndrome as Second-Line Treatment in primary care (ATLANTIS). Lancet, 2023.PMID 37858323
[7]Pimentel M, Lembo A, Chey WD et al. Rifaximin therapy for patients with irritable bowel syndrome without constipation. The New England journal of medicine, 2011.PMID 21208106
[9]Rao S, Lembo AJ, Shiff SJ et al. A 12-week, randomized, controlled trial with a 4-week randomized withdrawal period to evaluate the efficacy and safety of linaclotide in irritable bowel syndrome with constipation. The American journal of gastroenterology, 2012.PMID 22986440
[10]Halmos EP, Power VA, Shepherd SJ et al. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology, 2014.PMID 24076059
[11]O'Brien L, Kasti A, Halmos EP et al. Evolution, adaptation, and new applications of the FODMAP diet. JGH open, 2024.PMID 38770353
[12]Wallén H, Lindfors P, Andersson E et al. Return on investment of internet delivered exposure therapy for irritable bowel syndrome: a randomized controlled trial. BMC gastroenterology, 2021.PMID 34256715
[14]Daniluk J, Malecka-Wojciesko E, Skrzydlo-Radomanska B et al. The Efficacy of Mebeverine in the Treatment of Irritable Bowel Syndrome-A Systematic Review. Journal of clinical medicine, 2022.PMID 35207315
[16]Dilmaghani S, BouSaba J, Lupianez-Merly C et al. Meta-Analysis: Efficacy and Safety of Sequestrants for Bile Acid Diarrhoea. Alimentary pharmacology & therapeutics, 2025.PMID 41090475
[17]Sperber AD, Hreinsson JP, Simrén M et al. Rome V global epidemiology and validation survey: prevalence of disorders of gut-brain interaction and comparison with the Rome IV global epidemiology study. Gut, 2026.PMID 42613194
[18]Dalrymple J, Bullock I Diagnosis and management of irritable bowel syndrome in adults in primary care: summary of NICE guidance. BMJ, 2008.PMID 18325967
[15]Chang L, Sultan S, Lembo A et al. AGA Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome With Constipation. Gastroenterology, 2022.PMID 35738724

Irritable bowel syndrome — structured viva

Stem

You are the GP. Two extremes compete for your IBS pathway: scope everything, or FODMAP everything. ^[18]

References13Show

[2]Menees SB, Powell C, Kurlander J et al. A meta-analysis of the utility of C-reactive protein, erythrocyte sedimentation rate, fecal calprotectin, and fecal lactoferrin to exclude inflammatory bowel disease in adults with IBS. The American journal of gastroenterology, 2015.PMID 25732419
[4]Staudacher HM, Rucco V, Mancell S et al. Fiber supplementation in irritable bowel syndrome: a systematic review and meta-analysis of randomized controlled trials. Gastroenterology, 2026.PMID 42600900
[6]Ford AC, Wright-Hughes A, Alderson SL et al. Amitriptyline at Low-Dose and Titrated for Irritable Bowel Syndrome as Second-Line Treatment in primary care (ATLANTIS). Lancet, 2023.PMID 37858323
[7]Pimentel M, Lembo A, Chey WD et al. Rifaximin therapy for patients with irritable bowel syndrome without constipation. The New England journal of medicine, 2011.PMID 21208106
[9]Rao S, Lembo AJ, Shiff SJ et al. A 12-week, randomized, controlled trial with a 4-week randomized withdrawal period to evaluate the efficacy and safety of linaclotide in irritable bowel syndrome with constipation. The American journal of gastroenterology, 2012.PMID 22986440
[10]Halmos EP, Power VA, Shepherd SJ et al. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology, 2014.PMID 24076059
[11]O'Brien L, Kasti A, Halmos EP et al. Evolution, adaptation, and new applications of the FODMAP diet. JGH open, 2024.PMID 38770353
[12]Wallén H, Lindfors P, Andersson E et al. Return on investment of internet delivered exposure therapy for irritable bowel syndrome: a randomized controlled trial. BMC gastroenterology, 2021.PMID 34256715
[14]Daniluk J, Malecka-Wojciesko E, Skrzydlo-Radomanska B et al. The Efficacy of Mebeverine in the Treatment of Irritable Bowel Syndrome-A Systematic Review. Journal of clinical medicine, 2022.PMID 35207315
[16]Dilmaghani S, BouSaba J, Lupianez-Merly C et al. Meta-Analysis: Efficacy and Safety of Sequestrants for Bile Acid Diarrhoea. Alimentary pharmacology & therapeutics, 2025.PMID 41090475
[17]Sperber AD, Hreinsson JP, Simrén M et al. Rome V global epidemiology and validation survey: prevalence of disorders of gut-brain interaction and comparison with the Rome IV global epidemiology study. Gut, 2026.PMID 42613194
[18]Dalrymple J, Bullock I Diagnosis and management of irritable bowel syndrome in adults in primary care: summary of NICE guidance. BMJ, 2008.PMID 18325967
[15]Chang L, Sultan S, Lembo A et al. AGA Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome With Constipation. Gastroenterology, 2022.PMID 35738724