This week's Guidelines Side-By-Side Series will compare the irritable bowel syndrome (IBS) guidelines from the two prominent GI-related associations in the United States - AGA and ACG. Below is an overview of the three guidelines that will be compared side-by-side.
- Pharmacological Management of Irritable Bowel Syndrome With Diarrhea
- Published by the American Gastroenterological Association on June 21, 2022
- Pharmacological Management of Irritable Bowel Syndrome With Constipation
- Published by the American Gastroenterological Association on June 21, 2022
- Management of Irritable Bowel Syndrome
- Published by the American College of Gastroenterology (ACG) on January 1, 2021
The AGA guidelines, while technically two separate documents, were published together at the same time. Now, before tackling the recommendations, here are a couple key differences in terms of methodology and scope to take into consideration:
| Approach | AGA | ACG |
| Publication Date | June 21, 2022 | January 1, 2021 |
| Methodology | GRADE | GRADE/DELPHI |
| Grades Strength of Recommendation | Yes | Yes |
| Graded Level of Evidence | Yes | Yes |
| Based on Systematic Review | Yes | Yes |
| Multidisciplinary Panel | Yes | Not stated |
| Methodologist Involvement | Yes | Yes |
| Patient Representative(s) | Not stated | Not stated |
| Literature Search Through | April 21, 2020 | February 1, 2020 |
As you can see, both guidelines were developed in a very comparable way, both were published fairly close together, and the literature review periods also covered a similar scope of time. So with this set, let’s get into the individual recommendations!
Comparison of Pharmacological Recommendations for Irritable Bowel Syndrome with Diarrhea (IBS-D)
| Medication | AGA | ACG |
| Eluxadoline | Recommended (conditional, moderate quality of evidence) | Recommended (conditional, moderate quality of evidence) |
| Rifaximin | Recommended (conditional, moderate quality of evidence) | Recommended (strong, moderate quality of evidence) |
| Alosetron | Recommended (conditional, moderate quality of evidence) | Recommended (conditional, low quality of evidence) |
| Loperamide | Recommended (conditional, very low quality of evidence) | Not assessed/included in guidelines |
| Tricyclic antidepressants | Recommended (conditional, low quality of evidence) | Recommended (strong, moderate quality of evidence) |
| Selective serotonin reuptake inhibitors | NOT Recommended (conditional, low quality of evidence) | Not assessed/included in guidelines |
| Antispasmodics | Recommended (conditional, low quality of evidence) | NOT Recommended (conditional, low quality of evidence) |
| Bile acid sequestrants | Not assessed/included in guidelines | NOT Recommended (conditional, very low quality of evidence) |
Comparison of Pharmacological Recommendations for Irritable Bowel Syndrome with Constipation (IBS-C)
| Medication | AGA | ACG |
| Tenapanor | Recommended (conditional, moderate quality of evidence) | Not assessed/included in guidelines |
| Plecanatide | Recommended (conditional, moderate quality of evidence) | Recommended (strong, high quality of evidence) |
| Linaclotide | Recommended (strong, high quality of evidence) | Recommended (strong, high quality of evidence) |
| Tegaserod | Recommended (conditional, moderate quality of evidence) | Recommended (conditional, low quality of evidence) |
| Lubiprostone | Recommended (conditional, moderate quality of evidence) | Recommended (strong, moderate quality of evidence) |
| PEG laxatives | Recommended (conditional, low quality of evidence) | NOT Recommended (conditional, low quality of evidence) |
| Tricyclic antidepressants | Recommended (conditional, low quality of evidence) | Recommended (strong, moderate quality of evidence) |
| Selective serotonin reuptake inhibitors | NOT Recommended (conditional, low quality of evidence) | Not assessed/included in guidelines |
| Antispasmodics | Recommended (conditional, low quality of evidence) | NOT Recommended (conditional, low quality of evidence) |
Additional Comments on Comparing the ACG and AGA IBS Guidelines
Upon examination, it is evident that there are numerous similarities between the guidelines for irritable bowel syndrome (IBS), with a few notable differences. These variances include the utilization of antispasmodics, PEG laxatives, and other therapies, as well as the grading system assigned to each treatment.
It is crucial to emphasize that the American Gastroenterological Association (AGA) guidelines focus solely on pharmacotherapy for IBS, excluding other treatment modalities, screening recommendations, and diagnostic protocols. The AGA guidelines defer to the ROME Foundation and their ROME Criteria for the diagnostic aspect of IBS management. In contrast, the AGA guidelines encompass a broader spectrum, leading us to compare only the intersecting areas, specifically the pharmacological management of IBS-C and IBS-D.
What are your thoughts on this comparative analysis of irritable bowel syndrome guidelines? Do you find yourself aligning more with one organization over the other? We eagerly anticipate your feedback and insights. Contact us today and let us know!
Thank you for your readership, and we eagerly await the next installment of our Guidelines Side-By-Side Series!
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