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A 40-year-old woman with IBS experiences persistent abdominal pain and bloating despite dietary modification and antispasmodic therapy. She does not report constipation or diarrhoea.
What is the most appropriate next management step?

Increase fibre intake

Initiate low-dose amitriptyline

Start high-dose SSRI

Refer to colorectal surgery

Prescribe lactulose

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