ACG Clinical Guideline: Management of Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a highly prevalent, chronic disorder that significantly reduces patients' quality of life. Advances in diagnostic testing and in therapeutic options for patients with IBS led to the development of this first-ever American College of Gastroenterology clinical gu...

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Bibliographic Details
Published in:The American journal of gastroenterology Vol. 116; no. 1; pp. 17 - 44
Main Authors: Lacy, Brian E., Pimentel, Mark, Brenner, Darren M., Chey, William D., Keefer, Laurie A., Long, Millie D., Moshiree, Baha
Format: Journal Article
Language:English
Published: United States Wolters Kluwer 01.01.2021
Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
Subjects:
Abdomen
Antibodies
Biopsy
Brain research
Celiac Disease - diagnosis
Celiac Disease - immunology
Chloride Channel Agonists - therapeutic use
Cognitive Behavioral Therapy
Constipation - physiopathology
Constipation - therapy
Defecation
Delphi Technique
Diagnosis, Differential
Diarrhea
Diarrhea - physiopathology
Diarrhea - therapy
Diet Therapy
Disease
Disease Management
Feces - chemistry
Gastroenterology
Gastrointestinal Agents - therapeutic use
Guanylyl Cyclase C Agonists - therapeutic use
Humans
Hypnosis
Inflammatory Bowel Diseases - diagnosis
Irritable bowel syndrome
Irritable Bowel Syndrome - diagnosis
Irritable Bowel Syndrome - physiopathology
Irritable Bowel Syndrome - therapy
Leukocyte L1 Antigen Complex - analysis
Meta-analysis
Pain
Patients
Population
Rifaximin - therapeutic use
Serologic Tests
Societies, Medical
United States > US
North America
ISSN:0002-9270, 1572-0241, 1572-0241
Online Access:Get full text
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Summary:Irritable bowel syndrome (IBS) is a highly prevalent, chronic disorder that significantly reduces patients' quality of life. Advances in diagnostic testing and in therapeutic options for patients with IBS led to the development of this first-ever American College of Gastroenterology clinical guideline for the management of IBS using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Twenty-five clinically important questions were assessed after a comprehensive literature search; 9 questions focused on diagnostic testing; 16 questions focused on therapeutic options. Consensus was obtained using a modified Delphi approach, and based on GRADE methodology, we endorse the followingWe suggest that a positive diagnostic strategy as compared to a diagnostic strategy of exclusion be used to improve time to initiating appropriate therapy. We suggest that serologic testing be performed to rule out celiac disease in patients with IBS and diarrhea symptoms. We suggest that fecal calprotectin be checked in patients with suspected IBS and diarrhea symptoms to rule out inflammatory bowel disease. We recommend a limited trial of a low fermentable oligosaccharides, disacchardies, monosaccharides, polyols (FODMAP) diet in patients with IBS to improve global symptoms. We recommend the use of chloride channel activators and guanylate cyclase activators to treat global IBS with constipation symptoms. We recommend the use of rifaximin to treat global IBS with diarrhea symptoms. We suggest that gut-directed psychotherapy be used to treat global IBS symptoms. Additional statements and information regarding diagnostic strategies, specific drugs, doses, and duration of therapy can be found in the guideline.
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ISSN:0002-9270
1572-0241
1572-0241
DOI:10.14309/ajg.0000000000001036