Pharmacological Management of Irritable Bowel Syndrome With Diarrhea

Publication Date: June 21, 2022
Last Updated: April 19, 2023

Summary of Recommendations

Eluxadoline

In patients with IBS-D, the AGA suggests using eluxadoline ( Moderate , Conditional (weak) )
Implementation remark: eluxadoline is contraindicated in patients without a gallbladder or those who drink more than 3 alcoholic beverages per day
612

Rifaximin

In patients with IBS-D, the AGA suggests using rifaximin ( Moderate , Conditional (weak) )
612
In patients with IBS-D with initial response to rifaximin who develop recurrent symptoms, the AGA suggests retreatment with rifaximin ( Moderate , Conditional (weak) )
612

Alosetron

In patients with IBS-D, the AGA suggests using alosetron ( Moderate , Conditional (weak) )
612

Loperamide

In patients with IBS-D, the AGA suggests using loperamide ( Very Low , Conditional (weak) )
612

TCAs

In patients with IBS, the AGA suggests using TCAs ( Low , Conditional (weak) )
612

SSRIs

In patients with IBS, the AGA suggests against using SSRIs ( Low , Conditional (weak) )
612

Antispasmodics

In patients with IBS, the AGA suggests using antispasmodics ( Low , Conditional (weak) )
612

Video

Recommendation Grading

Overview

Title

Pharmacological Management of Irritable Bowel Syndrome With Diarrhea

Authoring Organization

Publication Month/Year

June 21, 2022

Last Updated Month/Year

February 6, 2024

Supplemental Implementation Tools

Document Type

Guideline

Country of Publication

US

Document Objectives

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder associated with significant disease burden. This American Gastroenterological Association Guideline is intended to support practitioners in decisions about the use of medications for the pharmacological management of IBS with predominant diarrhea (IBS-D) and is an update of a prior technical review and guideline.

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Treatment, Management

Diseases/Conditions (MeSH)

D043183 - Irritable Bowel Syndrome

Keywords

irritable bowel syndrome (IBS), IBS-D, IBS, irritable bowel syndrome with diarrhea

Source Citation

Lembo A, Sultan S, Chang L, et al. AGA Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome With Diarrhea. Gastroenterology. 2022;163:137-151.

Supplemental Methodology Resources

Data Supplement