Liver Dis. 2022 Dec 11;S1590-8658(22)00814-3.doi: 10.1016/j.dld.2022.11.015. Online ahead of print.

Giovanni Barbara ¹, Cesare Cremon ², Massimo Bellini ³, Maura Corsetti ⁴, Giovanni Di Nardo ⁵, Francesca Falangone ⁶, Lorenzo Fuccio ⁷, Francesca Galeazzi ⁸, Paola Iovino ⁹, Giovanni Sarnelli ¹⁰, Edoardo Vincenzo Savarino ⁸, Vincenzo Stanghellini ¹¹, Annamaria Staiano ¹², Cristina Stasi ², Cesare Tosetti ¹³, Rossella Turco ¹², Enzo Ubaldi ¹⁴, Rocco Maurizio Zagari ⁷, Letizia Zenzeri ⁵, Giovanni Marasco ²

Author information

¹IRCCS Azienda Ospedaliero Universitaria di Bologna, 40126 Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy. Electronic address: giovanni.barbara@unibo.it.

²IRCCS Azienda Ospedaliero Universitaria di Bologna, 40126 Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy.

³Gastrointestinal Unit, Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, 56010 Pisa, Italy.

⁴NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham Digestive Diseases Biomedical Research Centre, Nottingham, United Kingdom.

⁵NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy.

⁶Medical-Surgical Department of Clinical Sciences and Translational Medicine, University Sapienza, Rome, Italy.

⁷Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; Gastroenterology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40126 Bologna, Italy.

⁸Gastroenterology Unit, Azienda Ospedale Università di Padova, 35128 Padua, Italy.

⁹Gastrointestinal Unit Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Italy.

¹⁰Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy.

¹¹Health Care Agency of Ascoli Piceno, Ascoli Piceno, Italy.

¹²Department of Translational Medical Sciences-Section of Pediatric, University Federico II, 80100 Naples, Italy.

¹³Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy.

¹⁴Heath Care Agency of Bologna, Bologna, Italy.

Abstract

The irritable bowel syndrome (IBS) is a chronic disorder of gut-brain interaction. IBS is still associated with areas of uncertainties, especially regarding the optimal diagnostic work-up and the more appropriate management. Experts from 7 Italian Societies conducted a Delphi consensus with literature summary and voting process on 27 statements. Recommendations and quality of evidence were evaluated using the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus was defined as >80% agreement and reached for all statements. In terms of diagnosis, the consensus supports a positive diagnostic strategy with a symptom-based approach, including the psychological comorbidities assessment and the exclusion of alarm symptoms, together with the digital rectal examination, full blood count, C-reactive protein, serology for coeliac disease, and fecal calprotectin assessment. Colonoscopy should be recommended in patients with alarm features. Regarding treatment, the consensus strongly supports a dietary approach for patients with IBS, the use of soluble fiber, secretagogues, tricyclic antidepressants, psychologically directed therapies and, only in specific IBS subtypes, rifaximin. A conditional recommendation was achieved for probiotics, polyethylene glycol, antispasmodics, selective serotonin reuptake inhibitors and, only in specific IBS subtypes, 5-HT3 antagonists, 5-HT4 agonists, bile acid sequestrants.