- Fecal Incontinence
|Functional bowel disorders with diarrhoea: Clinical guidelines of the United European Gastroenterology and European Society for Neurogastroenterology and Motility
United European Gastroenterol J. 2022 Jul;10(6):556-584. doi: 10.1002/ueg2.12259.Epub 2022 Jun 13.
Edoardo Savarino 1, Fabiana Zingone 1, Brigida Barberio 1, Giovanni Marasco 2 3, Filiz Akyuz 4, Hale Akpinar 5, Oana Barboi 6 7, Giorgia Bodini 8, Serhat Bor 9, Giuseppe Chiarioni 10, Gheorghe Cristian 11, Maura Corsetti 12 13, Antonio Di Sabatino 14, Anca Mirela Dimitriu 15, Vasile Drug 6 7, Dan L Dumitrascu 16, Alexander C Ford 17 18, Goran Hauser 19, Radislav Nakov 20, Nisha Patel 21, Daniel Pohl 22, Catalin Sfarti 6 7, Jordi Serra 23 24 25, Magnus Simrén 26, Alina Suciu 15, Jan Tack 27, Murat Toruner 28, Julian Walters 29 30, Cesare Cremon 2 3, Giovanni Barbara 2 3
1Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
2Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
3Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
4Department of Gastroenterology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey.
5Department of Internal Medicine, Dokuz Eylül University School of Medicine, Izmir, Turkey.
6Department of Gastroenterology, 'Grigore T. Popa' University of Medicine and Pharmacy, Iasi, Romania.
7Institute of Gastroenterology and Hepatology, 'Saint Spiridon' Hospital, Iasi, Romania.
8Gastrointestinal Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy.
9Division of Gastroenterology, Ege University School of Medicine, Izmir, Turkey.
10Division of Gastroenterology, University of Verona, Verona, Italy.
11Fundeni Clinical Institute Center of Gastroenterology and Hepatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
12National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
13Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK.
14First Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
15Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, University of Medicine and Pharmacy, Bucharest, Romania.
162nd Department of Internal Medicine, 'Iuliu Hatieganu' University of Medicine and Farmacy, Cluj-Napoca, Romania.
17Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
18Leeds Institute of Medical Research at St. James's Sciences, University of Leeds, Leeds, UK.
19Department of Gastroenterology, Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.
20Department of Gastroenterology, Tsaritsa Yoanna University Hospital, Medical University of Sofia, Sofia, Bulgaria.
21Imperial College Healthcare NHS Trust, Institute of Global Health Innovation, St Mary's Hospital Campus, London, UK.
22Department of Gastroenterology, University Hospital Zurich, Zurich, Switzerland.
23Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Badalona, Spain.
24Digestive System Research Unit, University Hospital Vall d'Hebron, Barcelona, Spain.
25Department of Medicine, Autonomous University of Barcelona, Badalona, Spain.
26Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
27Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium.
28Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey.
29Division of Digestive Diseases, Department of Metabolism, Digestion, and Reproduction, Faculty of Medicine, Imperial College London, London, UK.
30Department of Gastroenterology, Division of Medicine and Integrated Care, Imperial College Healthcare NHS Trust, London, UK.
Irritable bowel syndrome with diarrhoea (IBS-D) and functional diarrhoea (FDr) are the two major functional bowel disorders characterized by diarrhoea. In spite of their high prevalence, IBS-D and FDr are associated with major uncertainties, especially regarding their optimal diagnostic work-up and management. A Delphi consensus was performed with experts from 10 European countries who conducted a literature summary and voting process on 31 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation criteria. Consensus (defined as >80% agreement) was reached for all the statements. The panel agreed with the potential overlapping of IBS-D and FDr. In terms of diagnosis, the consensus supports a symptom-based approach also with the exclusion of alarm symptoms, recommending the evaluation of full blood count, C-reactive protein, serology for coeliac disease, and faecal calprotectin, and consideration of diagnosing bile acid diarrhoea. Colonoscopy with random biopsies in both the right and left colon is recommended in patients older than 50 years and in presence of alarm features. Regarding treatment, a strong consensus was achieved for the use of a diet low fermentable oligo-, di-, monosaccharides and polyols, gut-directed psychological therapies, rifaximin, loperamide, and eluxadoline. A weak or conditional recommendation was achieved for antispasmodics, probiotics, tryciclic antidepressants, bile acid sequestrants, 5-hydroxytryptamine-3 antagonists (i.e. alosetron, ondansetron, or ramosetron). A multinational group of European experts summarized the current state of consensus on the definition, diagnosis, and management of IBS-D and FDr.