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American College of Gastroenterology Issues New Guidelines for IBS Treatment

Woman clutching stomach in pain.

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Key Takeaways

  • Researchers have released new guidelines for the diagnosis and treatment of IBS.
  • The goal is to shorten the time to diagnosis and help get patients the right treatment faster.
  • The guidelines include recommendations for diagnostic testing and therapeutic treatments.

The American College of Gastroenterology has published its first-ever clinical guidelines to help manage patients with irritable bowel syndrome (IBS). The new guidelines include clinical recommendations for diagnostic testing and therapeutic treatments for IBS.

The new guidelines published on December 14 in the American Journal of Gastroenterology, identify 25 important questions that doctors frequently ask patients. It then uses the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to evaluating the data. The hope, the guideline authors wrote, is to help get better, more targeted care to patients with IBS.

Irritable bowel syndrome is a group of symptoms that occur together, including repeated pain in your abdomen and changes in your bowel movements, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Doctors aren’t entirely sure what causes IBS, but many believe it’s caused by a problem with the gutbrain interaction.

These aren’t the first-ever guidelines on how to care for patients with IBS—those came out in 2014, guidelines co-author Darren Brenner, MD, a gastroenterologist at the Digestive Health Center at Northwestern Memorial Hospital, tells Verywell. However, this is the first time the GRADE system has been used. “This is a high-level advanced methodology to assess the rigor of clinical trials that have been done to date,” he says.

What This Means For You

If you struggle with IBS-like symptoms, talk to your doctor about the new guidelines and what they mean for you. These guidelines could potentially help you get a proper diagnosis quickly.

New Guidelines

The guidelines specify treatments and diagnostic studies that may be helpful for any particular patient, Brenner explains. “We’re hoping it will streamline the process for practitioners and shorten the time to appropriate therapy for patients,” he says.

The guidelines include the following, and more:

  • Diagnostic testing to rule out celiac disease and inflammatory bowel disease (IBD) in patients with suspected IBS and diarrhea, which is not routinely performed by many healthcare providers
  • Recommendations against routine colonoscopy in patients with IBS symptoms under age 45 who do not have warning signs like unintentional weight loss, older age of onset of symptoms, or family history of IBD, colon cancer, or other significant gastrointestinal diseases
  • Treatment of IBS with constipation (IBS-C) symptoms with guanylate cyclase activators and treatment of IBS with diarrhea (IBS-D) symptoms with a gut-selective antibiotic
  • The use of tricyclic antidepressants to treat global symptoms of IBS, including abdominal pain
  • Gut-directed psychotherapies to treat overall IBS symptoms as part of a comprehensive management strategy, rather than as a last resort, that can be used in conjunction with dietary therapies and medications

Currently, IBS is diagnosed by process of elimination but Brenner says he and his colleagues are hoping to change that. “Most people with IBS undergo extensive testing before they’re diagnosed which is many times unnecessary,” he says. These tests can include blood tests, stool tests, a hydrogen breath test, an upper GI endoscopy, and a colonoscopy, the NIDDK says.

The guidelines also give recommendations on the types of treatments that may be more effective than others. “We want to give the treatments that will work best, and we say what is unlikely to work for a profile as well,” Brenner says.

Current treatment for IBS typically includes changes in diet and lifestyle habits, probiotics, mental health therapies, and certain medications to treat diarrhea, constipation, or abdominal pain.

"I think this is a great tool," Ashkan Farhadi, MD, a gastroenterologist at MemorialCare Orange Coast Medical Center in California, who was not involved in creating the guidelines, tells Verywell. "This should help streamline the process of diagnosing patients—it can be very uncoordinated, doing different tests by different doctors."

The challenge, Farhadi says, is whether medical professionals will actually start to use these guidelines. "Whether they will take advantage of this or shelve it, that needs to be seen," he says.

Brenner hopes the guidelines will help improve the quality of life for people who struggle with IBS. “Quality of life is linked to symptoms,” he says. “If we can better treat them and give better evidence-based treatment, it will significantly improve quality of life.”

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  1. Lacy B, Pimentel M, Brenner D et al. ACG clinical guideline. American Journal of Gastroenterology. 2020;Publish Ahead of Print. doi:10.14309/ajg.0000000000001036

  2. National Institute of Diabetes and Digestive and Kidney Diseases. Irritable bowel syndrome (IBS).

  3. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms and causes of irritable bowel syndrome. Updated November 2017.

  4. National Institute of Diabetes and Digestive and Kidney Diseases. Diagnosis of irritable bowel syndrome. Updated November 2017.