Clinicians should tailor pharmacologic treatment of irritable bowel syndrome (IBS) with constipation (IBS-C) and diarrhea (IBS-D) to each individual patient, according to new guidelines from the American Gastroenterological Association (AGA).
The guidelines, which were published June 21 by Gastroenterology, discuss when to use new IBS drugs, when to use older FDA-approved drugs, and when to use over-the-counter drugs. A technical review panel developed each guideline by conducting an evidence review that prioritized clinical questions and outcomes by their importance to clinicians and patients. The guideline panel reviewed the evidence and developed recommendations using the Grading of Recommendations Assessment, Development, and Evaluation framework. The target audience for both guidelines includes primary care and gastroenterology clinicians, patients, and policymakers. For both guidelines, the comparator for all recommendations was no drug treatment.
For IBS-C, the guideline panel gave a strong recommendation for linaclotide (high certainty) and conditional recommendations for tenapanor, plecanatide, tegaserod, and lubiprostone (moderate certainty) and polyethylene glycol laxatives, tricyclic antidepressants, and antispasmodics (low certainty). The panel gave a conditional recommendation against the use of selective serotonin reuptake inhibitors (low certainty).
For IBS-D, the panel gave conditional recommendations for eluxadoline, rifaximin, and alosetron (moderate certainty); loperamide (very low certainty); and tricyclic antidepressants and antispasmodics (low certainty). The panel gave a conditional recommendation against the use of selective serotonin reuptake inhibitors (low certainty).
Both guidelines noted that IBS clinical trials have not as of yet included a biomarker for the different pathophysiologic mechanisms of IBS or one that can reliably predict treatment response to medications with different predominant mechanisms of action. “Dietary modification and behavioral treatments have shown beneficial effects in patients with IBS and should be considered on an individual basis, as these may be used in conjunction with pharmacological therapies,” the guideline authors wrote. “The efficacy of these interventions alone or in conjunction with pharmacological therapies was outside the scope this guideline.” Both guidelines also noted that more evidence is needed regarding the use of probiotics in IBS and called for additional studies on the effects of combined IBS treatments.
The AGA also recently released eight position statements aimed at reducing barriers to colorectal cancer screening and calling for payers to cover all expenses, including noninvasive tests and colonoscopies, without cost to patients. The statements were published June 14 by Gastroenterology.