ACG Clinical Guideline: Management of Irritable Bowel Syndrome

Am J Gastroenterol. 2020 Dec 14. doi: 10.14309/ajg.0000000000001036. Online ahead of print.

Brian E Lacy 1, Mark Pimentel 2, Darren M Brenner 3, William D Chey 4, Laurie A Keefer 5, Millie D Long 6, Baha Moshiree 7


Author information

  • 1Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
  • 2Division of Gastroenterology and Hepatology, Cedars-Sinai, Los Angeles, California, USA.
  • 3Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA.
  • 4Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA.
  • 5Icahn School of Medicine at Mount Sinai, New York, New York, USA.
  • 6Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA.
  • 7Division of Gastroenterology and Hepatology, University of North Carolina, College of Medicine, Charlotte, North Carolina, USA.


Irritable bowel syndrome (IBS) is a highly prevalent, chronic disorder that significantly reduces patients' quality of life. Advances in diagnostic testing and in therapeutic options for patients with IBS led to the development of this first-ever American College of Gastroenterology clinical guideline for the management of IBS using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Twenty-five clinically important questions were assessed after a comprehensive literature search; 9 questions focused on diagnostic testing; 16 questions focused on therapeutic options. Consensus was obtained using a modified Delphi approach, and based on GRADE methodology, we endorse the following: We suggest that a positive diagnostic strategy as compared to a diagnostic strategy of exclusion be used to improve time to initiating appropriate therapy. We suggest that serologic testing be performed to rule out celiac disease in patients with IBS and diarrhea symptoms. We suggest that fecal calprotectin be checked in patients with suspected IBS and diarrhea symptoms to rule out inflammatory bowel disease. We recommend a limited trial of a low fermentable oligosaccharides, disacchardies, monosaccharides, polyols (FODMAP) diet in patients with IBS to improve global symptoms. We recommend the use of chloride channel activators and guanylate cyclase activators to treat global IBS with constipation symptoms. We recommend the use of rifaximin to treat global IBS with diarrhea symptoms. We suggest that gut-directed psychotherapy be used to treat global IBS symptoms. Additional statements and information regarding diagnostic strategies, specific drugs, doses, and duration of therapy can be found in the guideline.

© Copyright 2013-2022 GI Health Foundation. All rights reserved.
This site is maintained as an educational resource for US healthcare providers only. Use of this website is governed by the GIHF terms of use and privacy statement.