Clinician reference tool — not medical advice. This is a clinical decision-aid intended for healthcare professionals: it gives deterministic suggestions to think with, not a diagnosis or a prescription. If you’re a patient, you’re welcome to look around — but please review anything here with your own doctor; it isn’t a substitute for personalized medical care.

Evidence: Health Canada — Drug Product Database & product monograph… 2026 · sources last checked 2026-08-20

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Ajax Harwood Clinic
IBS management selector — clinician decision-aid
Reference tool — not medical advice. Deterministic suggestions to think with, grounded in current guidelines and trials. Toggle the perspective to view options through the Health Canada (pharmacologic), Dietitian, or Naturopathic lens. Assumes a positive IBS diagnosis with red flags excluded. Clinician judgement, product monographs, and live coverage always required. Runs entirely in your browser — no data is collected.

IBS management selector

Pick the predominant bowel pattern and clinical context, and get ranked, reasoned management options across three clearly-labelled perspectives — each with its strength of evidence and the references behind it.

Clinical profile

Predominant bowel pattern(pick one)

Most bothersome symptom

Approach & context

Practical

Red flags & cautions

Alarm features prompt investigation first; the others gate specific agents.

Safety & guideline notes

  • • Low-FODMAP, gut-directed psychological therapies, and neuromodulators are best delivered with dietitian / specialist support; escalate refractory symptoms rather than stacking agents.

Perspective

Switch the lens you view options through

Start by picking the predominant bowel pattern.

Then add the most bothersome symptom and any preferences — e.g. IBS-C + bloating, or IBS-D + abdominal pain — and use the perspective toggle to compare the Health Canada, Dietitian, and Naturopathic options.

References

  1. [1]Lacy BE, et al. ACG Clinical Guideline: Management of Irritable Bowel Syndrome. Am J Gastroenterol 2021;116(1):17-44. link
  2. [2]Chang L, et al. AGA Clinical Practice Guideline on the Pharmacological Management of IBS with Constipation (IBS-C). Gastroenterology 2022;163(1):118-136. link
  3. [3]Lembo A, et al. AGA Clinical Practice Guideline on the Pharmacological Management of IBS with Diarrhea (IBS-D). Gastroenterology 2022;163(1):137-151. link
  4. [4]Vasant DH, et al. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut 2021;70:1214-1240. link
  5. [5]Ford AC, et al. Amitriptyline at low dose and titrated for IBS as second-line treatment in primary care (ATLANTIS): a randomised trial. Lancet 2023;402:1773-1785. (Positive; benefit modest — IBS-SSS −27, below ~35-pt MCID.) link
  6. [6]Pimentel M, et al. Rifaximin therapy for patients with IBS without constipation (TARGET 1 & 2). N Engl J Med 2011;364:22-32. link
  7. [7]Chapman RW, et al. Randomized clinical trial: macrogol/PEG 3350 improves constipation in IBS-C but not abdominal pain/global symptoms. Am J Gastroenterol 2013;108(9):1508-1515. link
  8. [8]Garsed K, et al. A randomised trial of ondansetron for the treatment of IBS with diarrhoea. Gut 2014. (Off-label; also TRITON, Aliment Pharmacol Ther 2023.) link
  9. [9]Sadowski DC, et al. Canadian Association of Gastroenterology Clinical Practice Guideline on the Management of Bile Acid Diarrhea. J Can Assoc Gastroenterol 2020;3:e10-e27. link
  10. [10]Health Canada — Drug Product Database & product monographs (verified Jul 2026): Constella (linaclotide, marketed), Trulance (plecanatide, marketed 2022), Resotran (prucalopride, approved for chronic idiopathic constipation), Zaxine (rifaximin, approved for IBS-D & hepatic encephalopathy), Viberzi (eluxadoline, marketed 2025), Amitiza (lubiprostone, never marketed), Ibsrela (tenapanor, DIN cancelled post-market Jun 2026). link
  11. [11]Canadian antispasmodic product monographs (Bentylol/dicyclomine, Buscopan/hyoscine butylbromide, Dicetel/pinaverium, Modulon/trimebutine) & CADTH review of pinaverium/trimebutine. link
  12. [12]FDA Drug Safety Communication: eluxadoline (Viberzi) — risk of serious pancreatitis, contraindicated without a gallbladder. (See also MHRA Truberzi advisory.) link
  13. [13]Johannesson E, et al. Physical activity improves symptoms in IBS: a randomized controlled trial (with 5-year follow-up). Am J Gastroenterol 2011. link
  14. [14]Gut-directed psychological therapy for IBS — meta-analyses of CBT and gut-directed hypnotherapy (robust effect on global symptoms; GRADE limited by blinding). Neurogastroenterol Motil 2025. link
  15. [15]Iberogast (STW-5) / greater celandine (Chelidonium majus) hepatotoxicity — NIH LiverTox; German BfArM 2018 mandated liver-injury warnings and pregnancy contraindication. (No Health Canada advisory located; a celandine-free 'Iberogast Advance' exists.) link
  16. [16]Melatonin for IBS — meta-analysis and RCT evidence of reduced abdominal pain/severity, particularly with coexisting sleep disturbance (limited quality). BMC Gastroenterol 2023. link
  17. [17]Health Canada (Dec 2025) — new mandated hepatotoxicity warning labels on turmeric/curcumin natural health products (rare idiosyncratic liver injury). Curcumin has no established IBS efficacy. link
  18. [18]Pregnancy/lactation sources — NIH LactMed (amitriptyline, PEG 3350); MotherToBaby; UKTIS (loperamide). PEG 3350 is the preferred constipation agent in pregnancy; avoid linaclotide/rifaximin/eluxadoline where possible. link
  19. [19]Ontario Drug Benefit (ODB) e-Formulary & live coverage checkers — prescription IBS agents are variably listed (often Limited Use) and IBS-D use of rifaximin is not publicly covered. Verify live before counselling. link
  20. [20]CADTH / CDA-AMC reimbursement reviews for IBS agents (inform, but do not equal, provincial formulary listing; Québec/RAMQ separate). link