Designed and created by Guideline Central in participation with the American Gastroenterological Association
Pharmacological Management of Irritable Bowel Syndrome with Diarrhea
Objective
Objective
This patient guide summarizes key takeaways from the American Gastroenterological Association (AGA) guideline for pharmacological management of irritable bowel syndrome with diarrhea. The purpose of this patient summary is to provide new evidence-based recommendations on the medications used for irritable bowel syndrome with diarrhea.
Overview
Overview
- Irritable bowel syndrome (IBS) is a common disorder that involves the interaction between the gut and the brain.
- IBS with diarrhea (IBS-D) is a subtype of IBS characterized by frequent episodes of diarrhea. It accounts for about 30% to 40% of IBS cases.
- To diagnose IBS-D, healthcare providers rely on a thorough medical history, physical examination, evaluation of gastrointestinal symptoms (including alarm signs), and the use of symptom-based criteria known as Rome IV criteria.
- Alarm features, such as new onset of symptoms after age 50, rectal bleeding unrelated to hemorrhoids or anal fissures, unintentional weight loss, iron deficiency anemia, nocturnal diarrhea, or a family history of colon cancer, inflammatory bowel disease, or celiac disease, may require additional investigations tailored to each patient.
Treatment
Treatment
- Eluxadoline is recommended for patients with IBS-D.
Eluxadoline should not be used if you do not have a gallbladder, or if you drink more than three alcoholic beverages per day.
- Rifaximin is recommended for patients with IBS-D. If you previously took rifamixin for IBS-D, but your symptoms come back, your retreatment rifaximin is recommended.
- Alosetron is recommended for patients with IBS-D.
- Loperamide is recommended for patients with IBS-D.
- Tricyclic antidepressants are recommended for patients with IBS of any type.
- Selective serotonin reuptake inhibitors are not recommended for IBS of any type.
- Antispasmodics are recommended for IBS of any type.
It's important to discuss all of these IBS-D medication options with your healthcare provider to determine which one may be most suitable for you. Your provider will consider your specific needs and medical history when making a recommendation.
Summary of Medication Recommendations for IBS-D
- Medications that are recommended for irritable bowel syndrome with diarrhea:
- eluxadoline (unless you drink more than 3 alcoholic beverages per day, or if you do not have a gallbladder)
- rifaximin
- alosetron
- loperamide
- Medications that are recommended for all types of irritable bowel syndrome
- tricyclic antidepressants
- antispasmodics
- Medications that are NOT recommended for irritable bowel syndrome of any type:
- selective serotonin reuptake inhibitors
Abbreviations
- AGA: American Gastroenterological Association
- IBS: Irritable Bowel Syndrome
- IBS-D: Irritable Bowel Syndrome With Diarrhea
- SSRIs: Selective Serotonin Reuptake Inhibitors
- TCAs: Tricyclic Antidepressants
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.