Management of Irritable Bowel Syndrome
Publication Date: December 31, 2020
Last Updated: March 14, 2022
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
Overview
Title
Management of Irritable Bowel Syndrome
Authoring Organization
American College of Gastroenterology
Publication Month/Year
December 31, 2020
Last Updated Month/Year
September 3, 2024
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.