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. 2021 Feb 4;56(3):193–217. doi: 10.1007/s00535-020-01746-z

Table 1.

Summarized questions and statements for irritable bowel syndrome JSGE clinical practice guidelines 2020

Q Step Subtype Contents Recommendation Level
BQ1-1 Prevalence
BQ1-2 Post-infectious IBS
BQ1-3 Stress
BQ1-4 Microbiota, mucosal permeability, low-grade inflammation
BQ1-5 Neurotransmitters, endocrine substances
BQ1-6 Psychological disturbances
BQ1-7 Genetics
BQ1-8 Pathophysiology among C, D, M, and U subtypes
BQ2-1 Diagnosis based on Rome IV criteria
CQ2-1 Colonoscopy Weak B
CQ2-2 Laboratory tests for differential diagnosis Strong B
CQ2-3 Some clinical tests for identifying IBS Weak B
CQ2-4 Laboratory tests for following-up Strong A
CQ3-1 1 Diet therapy Weak B
CQ3-2 1 Behavioral modification: Exercise Weak B
CQ3-3 1 Bulking polymer/dietary fiber Strong A
CQ3-4 1 Gastrointestinal motility modifiers Weak B
CQ3-5 1 Anticholinergics Weak B
CQ3-6 1 Probiotics Strong A
CQ3-7 1 D 5-HT3 receptor antagonists Strong A
CQ3-8 1 D Anti-diarrheal agents Weak C
CQ3-9 1 C Intestinal secretagogues Strong A
CQ3-10 1 C Bile acids/ileal bile acid transporter inhibitor Weak B
CQ3-11 1 C 5-HT4 agonists Weak B
CQ3-12 1 C Non-stimulant (osmotic) laxatives Weak C
CQ3-13 1 C Stimulant laxatives, on-demand use Weak D
CQ3-14 2 Antidepressants Weak A
CQ3-15 2 Anxiolytics for a short period Weak B
CQ3-16 3 Psychotherapy Strong B
CQ3-17 1/2 Kampo Weak C
CQ3-18 1/2 Anti-allergics Weak A
CQ3-19 1/2 Antibiotics Weak A
CQ3-20 2 Comprehensive alternative medicine: peppermint oil Weak A
CQ3-21 2 Narcotics Weak no C
CQ3-22 1–3 Prevent patients from leaving without treatment Weak C
FRQ3-1 2/3 Anti-psychotics, mood stabilizer
FRQ3-2 2/3 Fecal microbiota transplantation
FRQ3-3 1–3 Severity-dependent treatment
BQ4-1 Quality of life, medical seeking behavior
BQ4-2 Co-morbidity with FD, GERD, IBD
BQ4-3 Co-morbidity with extra-intestinal disorders

BQ background question, CQ clinical question, FRQ future research question, 5-HT 5-hydroxytryptamine, FD functional dyspepsia, GERD gastroesophageal reflux disease, IBD inflammatory bowel disease, Level A high evidence, Level B moderate evidence, Level C low evidence, Level D very low evidence, Step 1 the first step of therapeutic algorithm, Step 2 the second step of the therapeutic algorithm, Step 3 the third step of the therapeutic algorithm, Subtype C: constipation-predominant IBS, Subtype D diarrhea-predominant IBS