Table 2.
Differences between the ACG and CAG IBS guidelines
| Category of therapy | CAG guideline | ACG guideline |
|---|---|---|
| Alternative therapies | We suggest against offering herbal remedies to IBS patients to improve IBS symptoms | Not addressed |
| We suggest against offering acupuncture to IBS patients to improve IBS symptoms | Not addressed | |
| Microbiome | Not addressed | We suggest against the use of prebiotics and synbiotics for overall symptom improvement in IBS patients |
| The consensus group does not make a recommendation (neither for or against) offering diarrhea predominant IBS patients one course of rifaximin to improve IBS symptoms | We suggest the non-absorbable antibiotic rifaximin for reduction in global IBS symptoms as well as bloating in non-constipated IBS patients | |
| Pharmacological therapies | We suggest against offering diarrhea predominant IBS patients cholestyramine in improving IBS symptoms | Not addressed |
| We suggest against offering constipation predominant IBS patients prucalopride in improving OVERALL IBS symptoms | Not addressed | |
| Not addressed | We suggest plecanatide for overall symptom improvement in IBS-C patients | |
| Not addressed | We suggest alosetron for overall symptom improvement in female IBS-D patients | |
| Not addressed | We suggest against 5-aminosalicylates (5-ASAs) for overall symptom improvement in IBS patients | |
| Exercise | Not addressed | We suggest against the use of exercise for overall symptom improvement in IBS patients |
| Diagnostic testing | We suggest IBS patients have serological testing to exclude celiac disease | Not addressed |
| We recommend against testing for CRP in IBS patients to exclude inflammatory disorders | Not addressed | |
| We recommend against routine testing for fecal calprotectin in IBS patients to exclude inflammatory disorders | Not addressed | |
| We recommend against IBS patients < 50 years of age without alarm features ROUTINELY having colonoscopy to exclude alternate diagnoses | Not addressed | |
| We recommend against IBS patients < 50 years of age with alarm features ROUTINELY having colonoscopy to exclude alternate diagnoses | Not addressed | |
| We recommend IBS patients ≥ 50 years of age have a colonoscopy to exclude alternate diagnoses | Not addressed |