Management of Irritable Bowel Syndrome

Publication Date: January 1, 2021

Recommendations

We recommend that serologic testing be performed to rule out celiac disease in patients with IBS and diarrhea symptoms. (S, M)
620

Specific Testing

We suggest that fecal calprotectin and C-reactive protein be checked in patients without alarm features and with suspected IBS and diarrhea symptoms to rule out inflammatory bowel disease. (S, M)
620
We suggest that fecal lactoferrin be checked in patientswithout alarmfeatures and with suspected IBS and diarrhea symptoms to rule out inflammatory bowel disease. (S, VL)
620

We recommend against routine stool testing for enteric pathogens in all patients with IBS. (C, L)
620

We recommend against routine colonoscopy in patients with IBS symptoms younger than 45 years without warning signs. (C, L)
620

We suggest a positive diagnostic strategy as compared to a diagnostic strategy of exclusion for patients with symptoms of IBSs to improve time to initiate appropriate therapy. (, )
(Consensus)
620

We recommend a positive diagnostic strategy as compared to a diagnostic strategy of exclusion for patients with symptoms of IBSs to improve cost-effectiveness. (S, H)
620

We suggest that categorizing patients based on an accurate IBS subtype improves patient therapy. (, )
(Consensus)
620

We do not recommend testing for food allergies and food sensitivities in all patients with IBS unless there are reproducible symptoms concerning for a food allergy. (, )

(Consensus)

620

We suggest that anorectal physiology testing be performed in patients with IBS and symptoms suggestive of a pelvic floor disorder and/or refractory constipation not responsive to standard medical therapy. (, )
(Consensus)
620

We recommend a limited trial of a low FODMAP diet in patients with IBS to improve global IBS symptoms. (C, L)
620

We suggest that soluble, but not insoluble, fiber be used to treat global IBS symptoms. (S, M)
620

We recommend against the use of antispasmodics for the treatment of global IBS symptoms. (C, L)
620

We suggest the use of peppermint to provide relief of global IBS symptoms. (C, L)
620

We suggest against probiotics for the treatment of global IBS symptoms. (C, VL)
620

We suggest against PEG products to relieve global IBS symptoms in those with IBS-C. (C, L)
620

We recommend the use of chloride channel activators to treat global IBS-C symptoms. (S, M)
620

We recommend the use of guanylate cyclase activators to treat global IBS-C symptoms. (S, H)
620

We suggest that the 5-HT4 agonist tegaserod be used to treat IBS-C symptoms inwomen younger than 65 years with #1 cardiovascular risk factors who have not adequately responded to secretagogues. (, L)
(S/C)
620

We do not suggest the use of bile acid sequestrants to treat global IBS-D symptoms. (C, VL)
620

We recommend the use of rifaximin to treat global IBS-D symptoms. (S, M)
620

We recommend that alosetron be used to relieve global IBS-D symptoms in women with severe symptoms who have failed conventional therapy. (C, L)
620

We suggest that mixed opioid agonists/antagonists be used to treat global IBS-D symptoms. (C, M)
620

We recommend that tricyclic antidepressants be used to treat global symptoms of IBS. (S, M)
620

We suggest that gut-directed psychotherapies be used to treat global IBS symptoms. (C, VL)
620

Using currently available evidence, we recommend against the use of fecal transplant for the treatment of global IBS symptoms. (S, VL)
620

Recommendation Grading

Disclaimer

Overview

Title

Management of Irritable Bowel Syndrome

Authoring Organization

Publication Month/Year

January 1, 2021

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adult

Health Care Settings

Ambulatory, Long term care, Outpatient

Intended Users

Physician, dietician nutritionist, nurse, nurse practitioner, physician assistant

Scope

Assessment and screening, Diagnosis, Management

Diseases/Conditions (MeSH)

D043183 - Irritable Bowel Syndrome

Keywords

inflammatory bowel disease, irritable bowel syndrome (IBS), Gastrointestinal Disorder, Clinical guidelines

Source Citation

Lacy BE, Pimentel M, Brenner DM, Chey WD, Keefer LA, Long MD, Moshiree B. ACG Clinical Guideline: Management of Irritable Bowel Syndrome. Am J Gastroenterol. 2021 Jan 1;116(1):17-44. doi: 10.14309/ajg.0000000000001036. PMID: 33315591.

Supplemental Methodology Resources

Data Supplement