Gastroenterology. 2022 Jul;163(1):137-151.doi: 10.1053/j.gastro.2022.04.017.

Anthony Lembo ¹, Shahnaz Sultan ², Lin Chang ³, Joel J Heidelbaugh ⁴, Walter Smalley ⁵, G Nicholas Verne ⁶

Author information

¹Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

²Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota; Veterans Affairs Healthcare System, Minneapolis, Minnesota.

³Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California.

⁴Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan.

⁵Division of Gastroenterology, Vanderbilt University School of Medicine, Nashville, Tennessee.

⁶Department of Medicine, University of Tennessee College of Medicine, Memphis, Tennessee.

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).