Gastroenterology. 2022 Jul;163(1):118-136.doi: 10.1053/j.gastro.2022.04.016.

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

Author information

¹Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California.

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

³Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

⁴Department of Medicine, University of Tennessee College of Medicine, Memphis, Tennessee.

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

⁶Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan.

Abstract

Background & aims: Irritable bowel syndrome (IBS) is a common disorder of gut-brain interaction 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-C 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: tenapanor, plecanatide, linaclotide, tegaserod, lubiprostone, polyethylene glycol laxatives, 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 9 recommendations for the management of patients with IBS-C. The panel made a strong recommendation for linaclotide (high certainty) and conditional recommendations for tenapanor, plecanatide, tegaserod, and lubiprostone (moderate certainty), polyethylene glycol laxatives, tricyclic antidepressants, and antispasmodics (low certainty). The panel made a conditional recommendation against the use of selective serotonin reuptake inhibitors (low certainty).