Journal
GASTROENTEROLOGY
Volume 163, Issue 1, Pages 137-153Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.gastro.2022.04.017
Keywords
Irritable Bowel Syndrome; Treatment; Symptoms; Quality of Life; Randomized Controlled Trials; Meta-Analysis; Eluxadoline; Rifaximin; Alosetron; Antidiarrheals; Antispasmodics; Tricyclic Antidepressants; Selective Serotonin Reuptake Inhibitors
Categories
Funding
- National Institute of Diabetes and Digestive and Kidney Diseases [DK099052, DK118959]
- National Heart, Lung, and Blood Institute at the National Institute of Health for Asthma Guideline Development
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This article presents medication management guidelines for irritable bowel syndrome (IBS). The guidelines provide 8 recommendations for the pharmacological treatment of IBS-D patients, and evaluate the evidence and certainty of different medications.
BACKGROUND & AIMS: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder associated with significant disease burden. This American Gastroenterological Association Guideline is intended to support practitioners in decisions about the use of medications for the pharmacological management of IBS with predominant diarrhea (IBS-D) and is an update of a prior technical review and guideline. METHODS: The Grading of Recommendations Assessment, Development and Evaluation framework was used to assess evidence and make recommendations. The technical review panel prioritized clinical questions and outcomes according to their importance for clinicians and patients and conducted an evidence review of the following agents: eluxadoline, rifaximin, alosetron, loperamide, tricyclic antidepressants, selective serotonin reuptake inhibitors, and antispasmodics. The guideline panel reviewed the evidence and used the Evidence-to-Decision Framework to develop recommendations. CONCLUSIONS: The panel agreed on 8 recommendations for the management of patients with IBS-D. The panel made conditional recommendations for eluxadoline, rifaximin, alosetron, (moderate certainty), loperamide (very low certainty), tricyclic antidepressants, and anstispasmodics (low certainty). The panel made a conditional recommendation against the use of selective serotonin reuptake inhibitors (low certainty).
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