Table 1.
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