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Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Irritable Bowel Syndrome (IBS)

Paul Moayyedi, Christopher N Andrews, Glenda MacQueen and 9 more

Journal of the Canadian Association of Gastroenterology · 2019 · CC BY

doi:10.1093/jcag/gwy071

Abstract

Background & aims. Irritable bowel syndrome (IBS) is one of the most common gastrointestinal (GI) disorders, affecting about 10% of the general population globally. The aim of this consensus was to develop guidelines for the management of IBS.

Methods. A systematic literature search identified studies on the management of IBS. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Statements were developed through an iterative online platform and then finalized and voted on by a multidisciplinary group of clinicians and a patient.

Results. Consensus was reached on 28 of 31 statements. Irritable bowel syndrome is diagnosed based on symptoms; serological testing is suggested to exclude celiac disease, but routine testing for C-reactive protein (CRP), fecal calprotectin or food allergies is not recommended. A trial of a low fermentable oligosaccharides, disaccharides, monosaccharides, polyols (FODMAP) diet is suggested, while a gluten-free diet is not. Psyllium, but not wheat bran, supplementation may help reduce symptoms. Alternative therapies such as peppermint oil and probiotics are suggested, while herbal therapies and acupuncture are not. Cognitive behavioural therapy and hypnotherapy are suggested psychological therapies. Among the suggested or recommended pharmacological therapies are antispasmodics, certain antidepressants, eluxadoline, lubiprostone, and linaclotide. Loperamide, cholestyramine and osmotic laxatives are not recommended for overall IBS symptoms. The nature of the IBS symptoms (diarrhea-predominant or constipation-predominant) should be considered in the choice of pharmacological treatments.

Conclusions. Patients with IBS may benefit from a multipronged, individualized approach to treatment, including dietary modifications, psychological and pharmacological therapies.

References 177

  1. 1.

    Lacy BE, Mearin F, Chang L, et al Bowel disorders. Gastroenterology2016;150:1393–407.e5.

    Not in our library10.1053/j.gastro.2016.02.031

  2. 2.

    Lovell RM, Ford AC Global prevalence of and risk factors for irritable bowel syndrome: A meta-analysis. Clin Gastroenterol Hepatol2012;10(7):712–721.e4.

    Not in our library10.1016/j.cgh.2012.02.029

  3. 3.

    Sperber AD, Dumitrascu D, Fukudo S, et al The global prevalence of IBS in adults remains elusive due to the heterogeneity of studies: A Rome Foundation working team literature review. Gut2017;66(6):1075–82.

    Not in our library10.1136/gutjnl-2015-311240

  4. 4.

    Thompson WG, Irvine EJ, Pare P, et al Functional gastrointestinal disorders in Canada: First population-based survey using Rome II criteria with suggestions for improving the questionnaire. Dig Dis Sci2002;47(1):225–35.

    Not in our library10.1023/a:1013208713670

  5. 5.

    Palsson OS, van Tilburg MA, Simren M, et al Population prevalence of Rome IV and Rome III irritable bowel syndrome (IBS) in the United States (US), Canada and the United Kingdom (UK) [Abstract Mo1642]. Gastroenterology2016;150:S739–40.

    Not in our library

  6. 6.

    Drossman DA Functional gastrointestinal disorders: History, pathophysiology, clinical features and Rome IV. Gastroenterology2016;150:1262–79.

    Not in our library10.1053/j.gastro.2016.02.032

  7. 7.

    Ford AC, Moayyedi P, Lacy BE, et al al. American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. Am J Gastroenterol2014;109(Suppl 1):S2–26; quiz S27.

    Not in our library10.1038/ajg.2014.187

  8. 8.

    Chang L, Lembo A, Sultan S American Gastroenterological Association Institute Technical Review on the pharmacological management of irritable bowel syndrome. Gastroenterology2014;147(5):1149–72.e2.

    Not in our library10.1053/j.gastro.2014.09.002

  9. 9.

    Guyatt GH, Oxman AD, Vist GE, et al; GRADE Working Group GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. BMJ2008;336(7650):924–6.

    Not in our library10.1136/bmj.39489.470347.ad

  10. 10.

    Sultan S, Falck-Ytter Y, Inadomi JM The AGA institute process for developing clinical practice guidelines part one: Grading the evidence. Clin Gastroenterol Hepatol2013;11(4):329–32.

    Not in our library10.1016/j.cgh.2013.02.001

  11. 11.

    Bressler B, Marshall JK, Bernstein CN, et al; Toronto Ulcerative Colitis Consensus Group Clinical practice guidelines for the medical management of nonhospitalized ulcerative colitis: The Toronto consensus. Gastroenterology2015;148(5):1035–1058.e3.

    Not in our library10.1053/j.gastro.2015.03.001

  12. 12.

    Enns RA, Hookey L, Armstrong D, et al Clinical practice guidelines for the use of video capsule endoscopy. Gastroenterology2017;152(3):497–514.

    Not in our library10.1053/j.gastro.2016.12.032

  13. 13.

    Nguyen GC, Seow CH, Maxwell C, et al; IBD in Pregnancy Consensus Group; Canadian Association of Gastroenterology The Toronto consensus statements for the management of inflammatory bowel disease in pregnancy. Gastroenterology2016;150(3):734–757.e1.

    Not in our library10.1053/j.gastro.2015.12.003

  14. 14.

    Fallone CA, Chiba N, van Zanten SV, et al The Toronto consensus for the treatment of helicobacter pylori infection in adults. Gastroenterology2016;151(1):51–69.e14.

    Not in our library10.1053/j.gastro.2016.04.006

  15. 15.

    Nguyen GC, Bernstein CN, Bitton A, et al Consensus statements on the risk, prevention, and treatment of venous thromboembolism in inflammatory bowel disease: CANADIAN Association of Gastroenterology. Gastroenterology2014;146(3):835–848.e6.

    Not in our library10.1053/j.gastro.2014.01.042

  16. 16.

    Liu L, Andrews C, Armstrong D, et al Clinical practice guidelines for the assessment of uninvestigated esophageal dysphagia. J Can Assoc Gastroenterol2018;1:5–19.

    Not in our library10.1093/jcag/gwx008

  17. 17.

    Guyatt GH, Oxman AD, Kunz R, et al; GRADE Working Group Going from evidence to recommendations. BMJ2008;336(7652):1049–51.

    Not in our library10.1136/bmj.39493.646875.ae

  18. 18.

    Ford AC, Chey WD, Talley NJ, et al Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: Systematic review and meta-analysis. Arch Intern Med2009;169(7):651–8.

    Not in our library10.1001/archinternmed.2009.22

  19. 19.

    Zipser RD, Patel S, Yahya KZ, et al Presentations of adult celiac disease in a nationwide patient support group. Dig Dis Sci2003;48(4):761–4.

    Not in our library10.1023/a:1022897028030

  20. 20.

    Menees SB, Powell C, Kurlander J, et al A meta-analysis of the utility of C-reactive protein, erythrocyte sedimentation rate, fecal calprotectin, and fecal lactoferrin to exclude inflammatory bowel disease in adults with IBS. Am J Gastroenterol2015;110(3):444–54.

    Not in our library10.1038/ajg.2015.6

  21. 21.

    Sood R, Camilleri M, Gracie DJ, et al Enhancing diagnostic performance of symptom-based criteria for irritable bowel syndrome by additional history and limited diagnostic evaluation. Am J Gastroenterol2016;111(10):1446–54.

    Not in our library10.1038/ajg.2016.308

  22. 22.

    Ford AC, Bercik P, Morgan DG, et al Validation of the Rome III criteria for the diagnosis of irritable bowel syndrome in secondary care. Gastroenterology2013;145(6):1262–70.e1.

    Not in our library10.1053/j.gastro.2013.08.048

  23. 23.

    Hilmi I, Hartono JL, Pailoor J, et al Low prevalence of ‘classical’ microscopic colitis but evidence of microscopic inflammation in Asian irritable bowel syndrome patients with diarrhoea. BMC Gastroenterol2013;13:80.

    Not in our library10.1186/1471-230x-13-80

  24. 24.

    Ishihara S, Yashima K, Kushiyama Y, et al Prevalence of organic colonic lesions in patients meeting Rome III criteria for diagnosis of IBS: A prospective multi-center study utilizing colonoscopy. J Gastroenterol2012;47(10):1084–90.

    Not in our library10.1007/s00535-012-0573-4

  25. 25.

    Chey WD, Nojkov B, Rubenstein JH, et al The yield of colonoscopy in patients with non-constipated irritable bowel syndrome: Results from a prospective, controlled US trial. Am J Gastroenterol2010;105(4):859–65.

    Not in our library10.1038/ajg.2010.55

  26. 26.

    Gu HX, Zhang YL, Zhi FC, et al Organic colonic lesions in 3,332 patients with suspected irritable bowel syndrome and lacking warning signs, a retrospective case–control study. Int J Colorectal Dis2011;26(7):935–40.

    Not in our library10.1007/s00384-011-1163-2

  27. 27.

    Akhtar AJ, Shaheen MA, Zha J Organic colonic lesions in patients with irritable bowel syndrome (IBS). Med Sci Monit2006;12(9):CR363–7.

    Not in our library

  28. 28.

    Hamm LR, Sorrells SC, Harding JP, et al Additional investigations fail to alter the diagnosis of irritable bowel syndrome in subjects fulfilling the Rome criteria. Am J Gastroenterol1999;94(5):1279–82.

    Not in our library10.1111/j.1572-0241.1999.01077.x

  29. 29.

    El-Salhy M, Halwe J, Lomholt-Beck B, et al The prevalence of inflammatory bowel diseases, microscopic colitis, and colorectal cancer in patients with irritable bowel syndrome. Gastroenterol Insights2011;3:3.

    Not in our library

  30. 30.

    Şimşek Z, Tuncer NC, Alagüzlü H, et al Two gastrointestinal conditions with similar symptoms and endoscopic appearance: Irritable bowel syndrome and microscopic colitis. Turk J Med Sci2015;45(2):393–7.

    Not in our library10.3906/sag-1401-88

  31. 31.

    Ozdil K, Sahin A, Calhan T, et al The frequency of microscopic and focal active colitis in patients with irritable bowel syndrome. BMC Gastroenterol2011;11:96.

    Not in our library10.1186/1471-230x-11-96

  32. 32.

    Carmona-Sánchez R, Carrera-Álvarez MA, Pérez-Aguilar RM [Prevalence of microscopic colitis in patients with irritable bowel syndrome with diarrhea predominance]. Rev Gastroenterol Mex2011;76(1):39–45.

    Not in our library

  33. 33.

    Tunçer C, Cindoruk M, Dursun A, et al Prevalence of microscopic colitis in patients with symptoms suggesting irritable bowel syndrome. Acta Gastroenterol Belg2003;66(2):133–6.

    Not in our library

  34. 34.

    De Silva AP, Nandasiri SD, Hewavisenthi J, et al Subclinical mucosal inflammation in diarrhea-predominant irritable bowel syndrome (IBS) in a tropical setting. Scand J Gastroenterol2012;47(6):619–24.

    Not in our library10.3109/00365521.2012.666672

  35. 35.

    Pan CH, Chang CC, Su CT, et al Trends in irritable bowel syndrome incidence among Taiwanese adults during 2003–2013: A population-based study of sex and age differences. PLoS One2016;11:e0166922.

    Not in our library10.1371/journal.pone.0166922

  36. 36.

    Ford AC, Veldhuyzen van Zanten SJ, Rodgers CC, et al Diagnostic utility of alarm features for colorectal cancer: Systematic review and meta-analysis. Gut2008;57(11):1545–53.

    Not in our library10.1136/gut.2008.159723

  37. 37.

    Šimundić AM Measures of diagnostic accuracy: Basic definitions. ejifcc2009;19(4):203–11.

    Not in our library

  38. 38.

    Fuchs CS, Giovannucci EL, Colditz GA, et al a prospective study of family history and the risk of colorectal cancer. N Engl J Med1994;331(25):1669–74.

    Not in our library10.1056/nejm199412223312501

  39. 39.

    Bibbins-Domingo K, Grossman DC, Curry SJ, et al; US Preventive Services Task Force Screening for colorectal cancer: US preventive services task force recommendation statement. JAMA2016;315(23):2564–75.

    Not in our library10.1001/jama.2016.5989

  40. 40.

    Bacchus CM, Dunfield L, Gorber SC, et al; Canadian Task Force on Preventive Health C, Recommendations on screening for colorectal cancer in primary care. CMAJ2016;188:340–8.

    Not in our library10.1503/cmaj.151125

All 177 references

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