Table 1.

ACG Assessment and Recommendations for IBS-D Treatments^a

Statement	Evidence			Assessment
	Clinical Trials	Patients Treated (N)	RR Symptoms (95% CI)	Recommendation	Quality of Evidence
Specialized diets may improve symptoms in individual IBS patients	3	230	NA	Weak	Very low
There is insufficient evidence to recommend loperamide for use in IBS	2	42	0.51 (0.33-0.79)	Weak	Moderate
There is insufficient evidence to recommend antispasmodics available in the United Statesb	23	2154	0.69 (0.59-0.81)	Weak	Low
Peppermint oilc is superior to placebo in improving IBS symptoms	5c	482c	0.51c (0.33-0.79)	Weakc	Moderatec
Recommendations regarding individual species, preparations, or strains cannot be made because of insufficient and conflicting datad	23	2575	0.79 (0.70-0.89)	Weak	Low
TCAs are effective in providing symptom relief in IBS. Side effects are common and may limit patient tolerance	11	744	NR	Weak	High
Alosetron is effective in women with IBS-D	8	4987	0.79 (0.69-0.90)	Weak	Moderate
Eluxadoline is superior to placebo for the treatment of IBS-De	2e	2427e	NR	Stronge	Highe
Rifaximin is effective in reducing total IBS symptoms and bloating in IBS-D. Rifaximin is superior to placebo for the treatment of IBS-D	6e	2879e	0.84 (0.78-0.90)	Stronge	Highe

ACG, American College of Gastroenterology; IBS, irritable bowel syndrome; IBS-D, diarrhea-predominant irritable bowel syndrome; NR, not reported; RR, relative risk; TCAs, tricyclic antidepressants.

^aDoes not include data from TARGET 3.

^bRecommendation revised to reflect evidence for products available in the United States.

^cDoes not include triple-coated peppermint oil.

^dRecommendation revised to reflect monograph statement for individual products.

^eNew or modified recommendation based on data published since the ACG monograph.