Issue: February 2021
Perspective from Carine Bou-Abboud Matta, MD
Disclosures: Lacy reports consulting for and is on the scientific advisory board for Alpha Sigma, Arena Pharmaceuticals, Ironwood, Salix, Viver; Rome Board of Directors; Board of Trustees, American College of Gastroenterology. Please see the full report for all other author’s relevant financial disclosures.
December 15, 2020
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ACG develops guidelines for treatment of IBS

Issue: February 2021
Perspective from Carine Bou-Abboud Matta, MD
Disclosures: Lacy reports consulting for and is on the scientific advisory board for Alpha Sigma, Arena Pharmaceuticals, Ironwood, Salix, Viver; Rome Board of Directors; Board of Trustees, American College of Gastroenterology. Please see the full report for all other author’s relevant financial disclosures.
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The American College of Gastroenterology developed clinical guidelines for the treatment of irritable bowel syndrome.

“We believe that the information provided in this guideline will help guide both practitioners and researchers for years to come,” Brian E. Lacy, PhD, FACG, from the Mayo Clinic in Jacksonville, Florida, and colleagues said in recommendations published in the American Journal of Gastroenterology. “However, as this extensive project evolved, we recognized that there are still significant gaps in our knowledge. Future research is needed to better understand the role of the gut microbiome in patients with IBS and to understand the genesis of visceral pain.”

Lacy and colleagues used Grading of Recommendations, Assessment, Development and Evaluation methodology to evaluate 25 clinically important questions. Of these, nine questions focused on diagnostic testing and 16 questions focused on therapeutic options.

Among the 25 recommendations for IBS from the ACG are:

  • Fecal calprotectin, fecal lactoferrin and C-reactive protein should be checked in patients without alarm features and with suspected symptoms of IBS and diarrhea to rule out inflammatory bowel disease
  • Routine stool testing should not be performed for enteric pathogens in all IBS patients.
  • Routine colonoscopy should not be performed in patients with IBS symptoms aged younger than 45 years without warning signs.
  • A positive diagnostic strategy vs. a diagnostic strategy of exclusion should be used for patients with IBS symptoms to improve time to initiate appropriate therapy and cost-effectiveness.
  • Do not test for food allergies and sensitivities unless patients have reproducible symptoms concerning a food allergy.
  • Anorectal physiology testing should be performed in patients with IBS and symptoms that may suggest a pelvic floor disorder and refractory constipation.
  • Anti-spasmodics available in the United States should be used to treat global IBS.
  • Peppermint may be used to provide relief of global symptoms.
  • Mixed opioid agonists/antagonists should be used to treat global IBS-D symptoms.
  • A fecal transplant should not be used for the treatment of global IBS symptoms.

“Additional statements and information regarding diagnostic strategies, specific drugs, doses and duration of therapy can be found in the guideline,” the authors wrote.