AGA Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome With Diarrhea

Anthony Lembo, Shahnaz Sultan, Lin Chang, Joel J. Heidelbaugh, Walter Smalley, G. Nicholas Verne

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1 Scopus citations

Abstract

Background & Aims: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder associated with significant disease burden. This American Gastroenterological Association Guideline is intended to support practitioners in decisions about the use of medications for the pharmacological management of IBS with predominant diarrhea (IBS-D) and is an update of a prior technical review and guideline. Methods: The Grading of Recommendations Assessment, Development and Evaluation framework was used to assess evidence and make recommendations. The technical review panel prioritized clinical questions and outcomes according to their importance for clinicians and patients and conducted an evidence review of the following agents: eluxadoline, rifaximin, alosetron, loperamide, tricyclic antidepressants, selective serotonin reuptake inhibitors, and antispasmodics. The guideline panel reviewed the evidence and used the Evidence-to-Decision Framework to develop recommendations. Conclusions: The panel agreed on 8 recommendations for the management of patients with IBS-D. The panel made conditional recommendations for eluxadoline, rifaximin, alosetron, (moderate certainty), loperamide (very low certainty), tricyclic antidepressants, and anstispasmodics (low certainty). The panel made a conditional recommendation against the use of selective serotonin reuptake inhibitors (low certainty).

Original languageEnglish (US)
Pages (from-to)137-151
Number of pages15
JournalGastroenterology
Volume163
Issue number1
DOIs
StatePublished - Jul 2022

Bibliographical note

Funding Information:
Conflicts of interest These authors disclose the following: Lin Chang has served as a member of the scientific advisory boards for Ardelyx, Immunic, Ironwood Mauna Kea Technologies, and Protagonist. She has served as a consultant for Trellus and a speaker for Abbvie. She has received research support from the National Institute of Health, Arena, AnX Robotica, and Ironwood. She has stock options with ModifyHealth and Trellus. Anthony Lembo has served as a member of the scientific advisory board for Arena, Ardelyx, Bioamerica, IM HealthSciences, Ironwood, Mylan, Orpho-Med, Ritter, Shire, Takeda, Vibrant, and Allergan. He has received research support for clinical trials from National Institute of Health, Arena, Takeda, Vanda, and Vibrant, and Vanda. The remaining authors disclose no conflicts.Funding G. Nicholas Verne is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (DK099052 and DK118959). Shahnaz Sultan is supported by the National Heart, Lung, and Blood Institute at the National Institute of Health for Asthma Guideline Development.

Funding Information:
This document represents the official recommendations of the AGA and was developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. and adheres to best practices in guideline development, as outlined previously by the National Academy of Medicine (formerly Institute of Medicine). Development of this guideline was fully funded by the AGA Institute. 19

Funding Information:
Funding G. Nicholas Verne is supported by the National Institute of Diabetes and Digestive and Kidney Diseases ( DK099052 and DK118959 ). Shahnaz Sultan is supported by the National Heart, Lung, and Blood Institute at the National Institute of Health for Asthma Guideline Development.

Funding Information:
Conflicts of interest These authors disclose the following: Lin Chang has served as a member of the scientific advisory boards for Ardelyx, Immunic, Ironwood Mauna Kea Technologies, and Protagonist. She has served as a consultant for Trellus and a speaker for Abbvie. She has received research support from the National Institute of Health , Arena, AnX Robotica, and Ironwood. She has stock options with ModifyHealth and Trellus. Anthony Lembo has served as a member of the scientific advisory board for Arena, Ardelyx, Bioamerica, IM HealthSciences, Ironwood, Mylan, Orpho-Med, Ritter, Shire, Takeda, Vibrant, and Allergan. He has received research support for clinical trials from National Institute of Health, Arena, Takeda, Vanda, and Vibrant, and Vanda. The remaining authors disclose no conflicts.

Publisher Copyright:
© 2022

Keywords

  • Alosetron
  • Antidiarrheals
  • Antispasmodics
  • Eluxadoline
  • Irritable Bowel Syndrome
  • Meta-Analysis
  • Quality of Life
  • Randomized Controlled Trials
  • Rifaximin
  • Selective Serotonin Reuptake Inhibitors
  • Symptoms
  • Treatment
  • Tricyclic Antidepressants

PubMed: MeSH publication types

  • Practice Guideline

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