Pharmacological Management of Irritable Bowel Syndrome With Diarrhea

Publication Date: June 20, 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

American Gastroenterological Association

Publication Month/Year

June 20, 2022

Last Updated Month/Year

October 3, 2024

Supplemental Implementation Tools

Document Type

Guideline

Country of Publication

US

Document Objectives

The purpose of this guideline is to provide evidence-based recommendations for the pharmacological management of individuals with IBS-D based on a systematic and comprehensive synthesis of the literature. In addition, we included the recommendations for the following 3 classes of pharmacotherapeutic agents for IBS: tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and antispasmodics, not specific to one bowel subtype, which were included in the prior TR and guidelines.

Target Patient Population

Patients with irritable bowel syndrome with diarrhea

Target Provider Population

Primary care and gastroenterology health care professionals, patients, and policy makers.

PICO Questions

  1. Should Eluxadoline Be Used in Patients With Irritable Bowel Syndrome With Diarrhea?

  2. Should Rifaximin Be Used for Patients With Irritable Bowel Syndrome With Diarrhea for Initial Treatment and Retreatment?

  3. Should Alosetron Be Used in Patients With Irritable Bowel Syndrome With Diarrhea?

  4. Should Loperamide Be Used in Patients With Irritable Bowel Syndrome With Diarrhea?

  5. Should Tricyclic Antidepressants Be Used in Patients With Irritable Bowel Syndrome?

  6. Should Selective Serotonin Reuptake Inhibitors Be Used in Patients With Irritable Bowel Syndrome?

  7. Should Antispasmodics Be Used in Patients With Irritable Bowel Syndrome?

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