AGA Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome With Diarrhea

Gastroenterology. 2022 Jul;163(1):137-151.doi: 10.1053/j.gastro.2022.04.017.


Anthony Lembo 1Shahnaz Sultan 2Lin Chang 3Joel J Heidelbaugh 4Walter Smalley 5G Nicholas Verne 6


Author information

1Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

2Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota; Veterans Affairs Healthcare System, Minneapolis, Minnesota.

3Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California.

4Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan.

5Division of Gastroenterology, Vanderbilt University School of Medicine, Nashville, Tennessee.

6Department of Medicine, University of Tennessee College of Medicine, Memphis, Tennessee.


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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