An Evidence-Based Position Statement on the
Management of Irritable Bowel Syndrome by an
American College of Gastroenterology IBS Task Force

Irritable bowel syndrome (IBS) is a common disorder
characterized by abdominal pain and altered bowel habit
for at least 3 months. With this publication, an American
College of Gastroenterology Task Force updates the
2002 Monograph on IBS in light of new data. A series
of systematic reviews were performed to evaluate the
diagnostic yield of investigations and the efficacy of
treatments for IBS. The Task Force recommends that
further investigations are unnecessary in young patients
without alarm features with the exception of celiac sprue
serology, which may be of benefit in some patients. Further
investigation such as colonoscopy is recommended in those
over 50 years of age and in patients with alarm features.
Trials suggest psyllium fiber, certain antispasmodics, and
peppermint oil are effective in IBS patients although the
quality of the evidence is poor. Evidence suggests that
some probiotics may be effective in reducing overall IBS
symptoms but more data are needed. Antidiarrheals
reduce the frequency of stools but do not affect the overall
symptoms of IBS. 5HT3 antagonists are efficacious in
IBS patients with diarrhea and the quality of evidence is
good. Patients need to be carefully selected, however,
because of the risk of ischemic colitis. 5HT3 agonists are
modestly effective in IBS patients with constipation and
the quality of evidence is good although the possible risk of
cardiovascular events associated with these agents may limit
their utility. Tricyclic antidepressants and selective serotonin
reuptake inhibitors have been shown to be effective in IBS
patients of all subtypes. The trials generally are of good
quality but the limited number of patients included in
trials implies that further evidence could change the
confidence in the estimate of effect and therefore the
quality of evidence was graded as moderate. Nonabsorbable
antibiotics are effective particularly in diarrhea-predominant
IBS and selective C-2 chloride channel activators are
efficacious in constipation-predominant IBS with a moderate
quality of evidence. Psychological therapies may also provide
benefit to IBS patients although the quality of evidence is
poor.

American College of Gastroenterology IBS Task Force 2009 An Evidence-Based Position Statement on the Management of Irritable Bowel Syndrome
Am J Gastroenterology vol 104: S1 – S35;

blogger_blog:

www.nutrition-nutritionists.com

blogger_author:

Martin Eastwood

blogger_permalink:

/2009/07/irritable-bowel-syndrome-treatment.html