Moayyedi P¹, Andrews CN², MacQueen G³, Korownyk C⁴, Marsiglio M⁵, Graff L⁶, Kvern B⁷, Lazarescu A⁸, Liu L⁹, Paterson WG¹⁰, Sidani S¹, Vanner S¹⁰. J Can Assoc Gastroenterol. 2019 Apr;2(1):6-29. doi: 10.1093/jcag/gwy071. Epub 2019 Jan 17.

Author information

1 Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada.

2 Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada.

3 Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.

4 Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada.

5 Unaffliated.

6 Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.

7 Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

8 Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.

9 Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada.

10 Division of Gastroenterology, Queen's University, Kingston, Ontario, Canada.

Abstract

BACKGROUND & AIMS: Irritable bowel syndrome (IBS) is one of the most common gastrointestinal (GI) disorders, affecting about 10% of the general population globally. The aim of this consensus was to develop guidelines for the management of IBS.

METHODS: A systematic literature search identified studies on the management of IBS. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Statements were developed through an iterative online platform and then finalized and voted on by a multidisciplinary group of clinicians and a patient.

RESULTS: Consensus was reached on 28 of 31 statements. Irritable bowel syndrome is diagnosed based on symptoms; serological testing is suggested to exclude celiac disease, but routine testing for C-reactive protein (CRP), fecal calprotectin or food allergies is not recommended. A trial of a low fermentable oligosaccharides, disaccharides, monosaccharides, polyols (FODMAP) diet is suggested, while a gluten-free diet is not. Psyllium, but not wheat bran, supplementation may help reduce symptoms. Alternative therapies such as peppermint oil and probiotics are suggested, while herbal therapies and acupuncture are not. Cognitive behavioural therapy and hypnotherapy are suggested psychological therapies. Among the suggested or recommended pharmacological therapies are antispasmodics, certain antidepressants, eluxadoline, lubiprostone, and linaclotide. Loperamide, cholestyramine and osmotic laxatives are not recommended for overall IBS symptoms. The nature of the IBS symptoms (diarrhea-predominant or constipation-predominant) should be considered in the choice of pharmacological treatments.

CONCLUSIONS: Patients with IBS may benefit from a multipronged, individualized approach to treatment, including dietary modifications, psychological and pharmacological therapies.