Bethesda, MD (Nov. 5, 2014) — Up to 15 percent of the general adult population is affected by irritable bowel syndrome (IBS), and most patients struggle to find effective drug therapy. A new guideline from the American Gastroenterological Association (AGA) provides these patients and their physician's guidance. The new guideline and accompanying technical review have been published in Gastroenterology, the official journal of the AGA Institute.
"Because no IBS therapy is uniformly effective, many patients describe a history of a variety of treatments alone or in combination. This guideline will help patients and physicians navigate the drug options. It's also important to consider other clinically relevant information, such as a patient's values and preferences, when making treatment decisions," said Shahnaz Sultan, MD, MHSc, an author of the guidelines, from the gastroenterology section, Department of Veteran Affairs Medical Center, North Florida/South Georgia Veterans Health System.
The AGA developed the guideline using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology2 and best practices as outlined by the Institute of Medicine. Despite a large number of published studies on IBS therapies, in most cases, the quality of available data and or the balance of risks and benefits for a particular therapy did not overwhelmingly support the use of particular drugs. Additionally, there are no studies comparing the effectiveness of commonly used drugs to each other nor is there data comparing combinations of therapies to placebo or to each other.
Recognizing these limitations, the AGA Institute guidelines represent a rigorous, evidenced-based summary of extensive literature describing the use of drug treatments for IBS.
Patients with IBS-C (constipation)
- Recommends using linaclotide (over no drug treatment) in patients with IBS-C. (Strong recommendation; High-quality evidence)
- Suggests using lubiprostone (over no drug treatment) in patients with IBS-C. (Conditional recommendation; Moderate-quality evidence)
- Suggests using lubiprostone (over no drug treatment) in patients with IBS-C. (Conditional recommendation; Moderate-quality evidence)
Patients with IBS-D (diarrhea)
- Suggests using rifaximin (over no drug treatment) in patients with IBS–D. (Conditional recommendation; Moderate-quality evidence)
- Suggests using alosetron (over no drug treatment) in patients with IBS-D to improve global symptoms. (Conditional recommendation; Moderate evidence)
- Suggests using loperamide (over no drug treatment) in patients with IBS-D. (Conditional recommendation; Very low-quality evidence)
Patients with IBS
- Suggests using tricyclic antidepressants (over no drug treatment) in patients with IBS. (Conditional recommendation; Low-quality evidence)
- Suggests against using selective serotonin reuptake inhibitors for patients with IBS. (Conditional recommendation; Low-quality evidence)
- Suggests using antispasmodics (over no drug treatment) in patients with IBS. (Conditional recommendation; Low-quality evidence)
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Read the "American Gastroenterological Association Institute Guideline on the Use of Pharmacological Therapies in the Treatment of Irritable Bowel Syndrome" to review the treatment recommendations in its entirety.
To learn more about IBS, read the AGA patient brochure at http://www.gastro.org/patient-center/digestive-conditions/irritable-bowel-syndrome.
AGA's guidelines are created using a process that employs the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. GRADE has been adopted by several national and international societies, including the AGA, and is becoming the common methodology for the streamlined and rigorous development of clear, transparent and actionable guidelines.
1 Weinberg D S J P. American Gastroenterological Association Institute Guideline on the Use of Pharmacological Therapies in the Treatment of Irritable Bowel Syndrome. Gastroenterology 2014;147(5):1146-1148.
Chang L et al. American Gastroenterological Association Institute Technical Review on the Pharmacological Management of Irritable Bowel Syndrome. Gastroenterology 2014; 147(5):1149–1172.e2
About the AGA Institute
The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, the AGA has grown to include 17,000 members from around the globe who are involved in all aspects of the science, practice and advancement of gastroenterology. The AGA Institute administers the practice, research and educational programs of the organization. http://www.gastro.org.
About Gastroenterology
Gastroenterology, the official journal of the AGA Institute, is the most prominent scientific journal in the specialty and is in the top 1 percent of indexed medical journals internationally. The journal publishes clinical and basic science studies of all aspects of the digestive system, including the liver and pancreas, as well as nutrition. The journal is abstracted and indexed in Biological Abstracts, Current Awareness in Biological Sciences, Chemical Abstracts, Current Contents, Excerpta Medica, Index Medicus, Nutrition Abstracts and Science Citation Index. For more information, visit http://www.gastrojournal.org.
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