Table 1.
Summary of consensus recommendations for the management of IBS
| DIAGNOSTIC TESTING FOR IBS |
|---|
| 1: We suggest IBS patients have serological testing to exclude celiac disease. GRADE: Conditional recommendation, low-quality evidence |
| 2: We recommend AGAINST testing for CRP in IBS patients to exclude inflammatory disorders. GRADE: Strong recommendation, very low-quality evidence |
| 3: We recommend AGAINST routine testing for fecal calprotectin in IBS patients to exclude inflammatory disorders. GRADE: Strong recommendation, very low-quality evidence |
| 4: We recommend AGAINST IBS patients <50 years of age without alarm features ROUTINELY having a colonoscopy to exclude alternate diagnoses. GRADE: Strong recommendation, very low-quality evidence |
| 5: We suggest AGAINST IBS patients <50 years of age with alarm features ROUTINELY having a colonoscopy to exclude alternate diagnoses. GRADE: Conditional recommendation, very low-quality evidence |
| 6: We recommend patients with new-onset IBS symptoms at ≥50 years of age have colonoscopy to exclude alternative diagnoses. GRADE: Strong recommendation, low-quality evidence |
| 7: We recommend AGAINST IBS patients having food allergy testing to identify triggers of IBS symptoms. GRADE: Strong recommendation, very low-quality evidence |
| 8: We recommend AGAINST the routine use of lactose hydrogen breath tests in evaluating IBS patients. GRADE: Strong recommendation, very low-quality evidence |
| 9: We recommend AGAINST the routine use of glucose hydrogen breath tests in evaluating IBS patients. GRADE: Strong recommendation, very low-quality evidence |
| DIETARY MODIFICATIONS AND ALTERNATIVE THERAPIES FOR IBS |
| 10: We suggest offering IBS patients a low FODMAP diet to reduce IBS symptoms. GRADE: Conditional recommendation, very low-quality evidence |
| 11: We suggest AGAINST offering IBS patients a gluten-free diet to reduce IBS symptoms. GRADE: Conditional recommendation, very low-quality evidence |
| 12: We suggest AGAINST offering IBS patients wheat bran supplementation to improve IBS symptoms. GRADE: Conditional recommendation, low-quality evidence |
| 13: We recommend offering IBS patients psyllium supplementation to improve IBS symptoms. GRADE: Strong recommendation, moderate-quality evidence |
| 14: We suggest AGAINST offering herbal remedies to IBS patients to improve IBS symptoms. GRADE: Conditional recommendation, very low-quality evidence |
| 15: We recommend AGAINST offering acupuncture to IBS patients to improve IBS symptoms. GRADE: Strong recommendation, very low-quality evidence |
| 16: We suggest offering IBS patients peppermint oil to improve IBS symptoms. GRADE: Conditional recommendation, low-quality evidence |
| 17: We suggest offering IBS patients probiotics to improve IBS symptoms. GRADE: Conditional recommendation, low-quality evidence |
| PSYCHOLOGICAL THERAPIES FOR IBS |
| 18: We suggest offering IBS patients cognitive behavioral therapy to improve IBS symptoms. GRADE: Conditional recommendation, very low-quality evidence |
| 19: We suggest offering IBS patients hypnotherapy to improve IBS symptoms. GRADE: Conditional recommendation, very low-quality evidence |
| PHARMACOLOGICAL THERAPIES FOR IBS |
| 20: We suggest offering IBS patients certain antispasmodics (such as dicyclomine, hyoscine, pinaverium) to improve IBS symptoms. GRADE: Conditional recommendation, very low-quality evidence |
| 21: We recommend offering IBS patients low-dose tricyclic antidepressants to improve IBS symptoms. GRADE: Strong recommendation, high-quality evidence |
| 22: We suggest offering IBS patients SSRIs to improve IBS symptoms. GRADE: Conditional recommendation, moderate-quality evidence |
| PHARMACOLOGICAL THERAPIES FOR IBS |
| 23: We suggest AGAINST offering diarrhea-predominant IBS patients continuous loperamide use to improve IBS symptoms. GRADE: Conditional recommendation, very low-quality evidence |
| 24: We suggest AGAINST offering diarrhea-predominant IBS patients cholestyramine to improve IBS symptoms. GRADE: Conditional recommendation, very low-quality evidence |
| 25: We suggest offering diarrhea-predominant IBS patients eluxadoline to improve IBS symptoms. GRADE: Conditional recommendation, moderate-quality evidence |
| 26: We suggest AGAINST offering constipation-predominant IBS patients osmotic laxatives to improve OVERALL IBS symptoms. GRADE: Conditional recommendation, very low-quality evidence |
| 27: We suggest AGAINST offering constipation-predominant IBS patients prucalopride to improve OVERALL IBS symptoms. GRADE: Conditional recommendation, very low-quality evidence |
| 28: We suggest offering constipation-predominant IBS patients lubiprostone to improve IBS symptoms. GRADE: Conditional recommendation, moderate-quality evidence |
| 29: We recommend offering constipation-predominant IBS patients linaclotide to improve IBS symptoms. GRADE: Strong recommendation, high-quality evidence |
| STATEMENTS WITH NO RECOMMENDATIONS |
|
No recommendation A:
The consensus group does not make a recommendation (neither for nor against) offering IBS patients relaxation techniques to improve IBS symptoms.
No recommendation B: The consensus group does not make a recommendation (neither for nor against) offering IBS patients short-term psychodynamic psychotherapy to improve IBS symptoms. No recommendation C: The consensus group does not make a recommendation (neither for nor against) offering diarrhea-predominant IBS patients one course of rifaximin therapy to improve IBS symptoms. |
*The strength of each recommendation was assigned by the consensus group, per the GRADE system, as strong (‘we recommend . . .’) or conditional (‘we suggest . . .’). A recommendation could be classified as strong despite low quality evidence to support it, or conditional despite the existence of high-quality evidence due to the four components considered in each recommendation (risk:benefit balance, patients’ values and preferences, cost and resource allocation, and quality of evidence).