Table 2.
ACG Assessment and Recommendations for IBS-C and CIC Treatments
| Statement | Evidence | Assessment | |||
|---|---|---|---|---|---|
| Clinical Trials | Patients Treated (N) | RR Symptoms (95% CI) | Recommendation | Quality of Evidence | |
| IBS-C | |||||
| Fiber provides overall symptom relief in IBS. Fiber can cause bloating and abdominal discomfort | 14 | 906 | 0.86 (0.80-0.94) | Weak | Moderate |
| Psyllium, but not bran, provides overall symptom relief in IBS | 7 | 499 | 0.83 (0.73-0.94) | Weak | Moderate |
| There is no evidence that PEG improves overall symptoms and pain in patients with IBS | 2 | 166 | NA | Weak | Very low |
| SSRIs are effective in providing symptom relief in IBS. Side effects are common and may limit patient tolerance | 7 | 356 | NR | Weak | High |
| Lubiprostone is superior to placebo for the treatment of IBS-C | 3 | 1366 | 0.91 (0.87-0.95) | Strong | Moderate |
| Linaclotide is superior to placebo for the treatment of IBS-C | 3 | 2028 | 0.80 (0.75-0.85) | Strong | High |
| CIC | |||||
| Some fiber supplements increase stool frequency in patients with CIC | 3 | 293 | 0.25 (0.16-0.37) | Strong | Low |
| Sodium picosulfate and bisacodyl are effective in CIC | 2 | 735 | 0.54 (0.42-0.69) | Strong | Moderate |
| PEG is effective in increasing stool frequency and improving stool consistency in CIC | 4 | 573 | 0.52 (0.41-0.65) | Strong | High |
| Lubiprostone is superior to placebo for the treatment of CIC | 4 | 651 | 0.67 (0.58-0.77) | Strong | High |
| Linaclotide is superior to placebo for the treatment of CIC | 3 | 1582 | 0.84 (0.80-0.87) | Strong | High |
ACG, American College of Gastroenterology; CIC, chronic idiopathic constipation; IBS, irritable bowel syndrome; IBS-C, constipation-predominant irritable bowel syndrome; NA, not available; NR, not reported; PEG, polyethylene glycol; RR, relative risk; SSRIs, selective serotonin reuptake inhibitors.