guidelines

AGA Updates IBS-D Guidelines

The American Gastroenterological Association (AGA) has released updated clinical practice guidelines for the management of irritable bowel syndrome with diarrhea (IBS-D) with pharmacological therapies.

These recommendations are 1 of 2 related guidelines. The second set of guidelines focuses on the management of irritable bowel syndrome with constipation (IBS-C). Together, these documents update the group’s 2014 IBS technical review.

Among the recommendations included for the management of IBS-D are:

  • Eluxadoline may be used, except in patients without a gallbladder or those who consume more than 3 alcoholic drinks per day (Conditional recommendation, moderate level of certainty)
  • Rifaximin may be used as both an initial treatment and retreatment in those with recurrent symptoms who had initially responded to rifaximin (Conditional recommendation, moderate level of certainty)
  • Alosetron may be used (Conditional recommendation, moderate level of certainty)

Unchanged from the 2014 guideline, tricyclic antidepressants, selective serotonin reuptake inhibitors, and antispasmodics may also be used to treat symptoms of IBS-D (conditional recommendation, low certainty of evidence). Although data is lacking on the optimal dose and methods of use, loperamide may also be used to treat IBS-D (conditional recommendation, very low certainty of evidence).

“This guideline is helpful in outlining the newer pharmacotherapeutic agents recommended for use in managing symptoms of IBS-D,” concluded the guideline authors. “Acknowledging that multimodal treatments that include dietary and behavioral approaches in conjunction with drug therapy may provide maximum benefits and that treatment choices may be influenced by patient preferences, practitioners should engage in shared decision making with patients when choosing the best therapy.”

 

—Leigh Precopio

 

Reference:

Lembo A, Sultan S, Chang L, Heidelbaugh JJ, Smalley W, Verne GN. AGA clinical practice guideline on the pharmacological management of irritable bowel syndrome with diarrhea. Gastroenterology. 2022;163(1):137-151. doi:10.1053/j.gastro.2022.04.017

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