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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| Published in: | The American journal of gastroenterology Vol. 116; no. 1; pp. 17 - 44 |
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| Main Authors: | , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
Wolters Kluwer
01.01.2021
Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins |
| Subjects: | |
| ISSN: | 0002-9270, 1572-0241, 1572-0241 |
| Online Access: | Get full text |
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| Abstract | 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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| AbstractList | 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 following: We 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. 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. 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 following: We 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.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 following: We 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. |
| Author | Pimentel, Mark Lacy, Brian E. Long, Millie D. Keefer, Laurie A. Brenner, Darren M. Moshiree, Baha Chey, William D. |
| AuthorAffiliation | Division of Gastroenterology and Hepatology, Cedars-Sinai, Los Angeles, California, USA Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA Icahn School of Medicine at Mount Sinai, New York, New York, USA Division of Gastroenterology and Hepatology, University of North Carolina, College of Medicine, Charlotte, North Carolina, USA Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA |
| AuthorAffiliation_xml | – name: Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA – name: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA – name: Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA – name: Division of Gastroenterology and Hepatology, University of North Carolina, College of Medicine, Charlotte, North Carolina, USA – name: Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA – name: Division of Gastroenterology and Hepatology, Cedars-Sinai, Los Angeles, California, USA – name: Icahn School of Medicine at Mount Sinai, New York, New York, USA |
| Author_xml | – sequence: 1 givenname: Brian E. surname: Lacy fullname: Lacy, Brian E. organization: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA – sequence: 2 givenname: Mark surname: Pimentel fullname: Pimentel, Mark organization: Division of Gastroenterology and Hepatology, Cedars-Sinai, Los Angeles, California, USA – sequence: 3 givenname: Darren M. surname: Brenner fullname: Brenner, Darren M. organization: Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA – sequence: 4 givenname: William D. surname: Chey fullname: Chey, William D. organization: Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA – sequence: 5 givenname: Laurie A. surname: Keefer fullname: Keefer, Laurie A. organization: Icahn School of Medicine at Mount Sinai, New York, New York, USA – sequence: 6 givenname: Millie D. surname: Long fullname: Long, Millie D. organization: Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA – sequence: 7 givenname: Baha surname: Moshiree fullname: Moshiree, Baha organization: Division of Gastroenterology and Hepatology, University of North Carolina, College of Medicine, Charlotte, North Carolina, USA |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33315591$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | Wolters Kluwer Copyright © 2020 by The American College of Gastroenterology. 2020 by The American College of Gastroenterology |
| Copyright_xml | – notice: Wolters Kluwer – notice: Copyright © 2020 by The American College of Gastroenterology. – notice: 2020 by The American College of Gastroenterology |
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| DOI | 10.14309/ajg.0000000000001036 |
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| SubjectTerms | 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 |
| Title | ACG Clinical Guideline: Management of Irritable Bowel Syndrome |
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