Check for something new as infectious. Try eliminating milk products for 10 days , then wheat, gluten. If you show concern, she will improve with time. She would like to know the attitude of her doctor towards her condition, his knowledge and compassion, and how serious is he about her condition. To this end I would tell her to try Lotronex 1mg b.i.d. as she didn't try before, I would tell her to call me any time if the symptoms get worse, and if they remain the same or improve, to see me in a month.
Patients often remain apathic about their condition and they expect everything from the doctor.
I explain them upfront that they have to contribute to their improvement not only by taking the pill twice daily but also by following my instructions such as filling the tedious diet diary which they may have done in the past already for another doctor and the diary and intensity of the gas pains and flatulence. After all of this is said and done there are as many variants to treat this condition as there are personnalities.