Management of Irritable Bowel Syndrome(beta)
We suggest that fecal calprotectin (or fecal lactoferrin) and C-reactive protein be checked in patients without alarm features and with suspected IBS and diarrhea symptoms to rule out inflammatory bowel disease. moderate quality of evidence for C-reactive protein and fecal calprotectin.
We suggest a positive diagnostic strategy as compared to a diagnostic strategy of exclusion for patients with symptoms of IBS to improve time to initiate appropriate therapy.
We recommend a limited trial of a low FODMAP diet in patients with IBS to improve global IBS symptoms.
We suggest that soluble, but not insoluble, fiber be used to treat global IBS symptoms.
We recommend against the use of antispasmodics for the treatment of global IBS symptoms.
We suggest the use of peppermint to provide relief of global IBS symptoms.
We suggest against probiotics for the treatment of global IBS symptoms.
We recommend that tricyclic antidepressants be used to treat global symptoms of IBS.
We suggest that gut-directed psychotherapies be used to treat global IBS symptoms.
We suggest against PEG products to relieve global IBS symptoms in those with IBS-C.
We recommend the use of chloride channel activators to treat global IBS-C symptoms.
We recommend the use of guanylate cyclase activators to treat global IBS-C symptoms.
We do not suggest the use of bile acid sequestrants to treat global IBS-D symptoms.
We recommend the use of rifaximin to treat global IBS-D symptoms.
We recommend that alosetron be used to relieve global IBS-D symptoms in women with severe symptoms who have failed conventional therapy.
How strong is the ACG's recommendation?