Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Irritable Bowel Syndrome (IBS)

Abstract

Background & aims Irritable bowel syndrome (IBS) is one of the most common gastrointestinal (GI) disorders, affecting about 10% of the general population globally. The aim of this consensus was to develop guidelines for the management of IBS. Methods A systematic literature search identified studies on the management of IBS. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Statements were developed through an iterative online platform and then finalized and voted on by a multidisciplinary group of clinicians and a patient. Results Consensus was reached on 28 of 31 statements. Irritable bowel syndrome is diagnosed based on symptoms; serological testing is suggested to exclude celiac disease, but routine testing for C-reactive protein (CRP), fecal calprotectin or food allergies is not recommended. A trial of a low fermentable oligosaccharides, disaccharides, monosaccharides, polyols (FODMAP) diet is suggested, while a gluten-free diet is not. Psyllium, but not wheat bran, supplementation may help reduce symptoms. Alternative therapies such as peppermint oil and probiotics are suggested, while herbal therapies and acupuncture are not. Cognitive behavioural therapy and hypnotherapy are suggested psychological therapies. Among the suggested or recommended pharmacological therapies are antispasmodics, certain antidepressants, eluxadoline, lubiprostone, and linaclotide. Loperamide, cholestyramine and osmotic laxatives are not recommended for overall IBS symptoms. The nature of the IBS symptoms (diarrhea-predominant or constipation-predominant) should be considered in the choice of pharmacological treatments. Conclusions Patients with IBS may benefit from a multipronged, individualized approach to treatment, including dietary modifications, psychological and pharmacological therapies.

How Serotonin Level Fluctuation Affects the Effectiveness of Treatment in Irritable Bowel Syndrome

“…Patients with IBS are treated based on the predominance of their symptoms. However, an exact treatment plan is not known [ 11 ]. Since the cause of IBS is not exactly identified, it is difficult to screen for the disease, and on the same point, it is hard to look for preventive measures [ 12 ].…”

The role of physical exercise in the treatment of IBS

“…Among guidelines published in the past 5 years, some include a weak recommendation of moderate exercise as a lifestyle change for the treatment of IBS, supported by a low evidence [78][79][80][81][82][83][84] , while others do not include any reference either in favor or against [85][86][87] .…”

Diet therapy for irritable bowel syndrome

“…Традиционные рекомендации по питанию пациентов с заболеваниями кишечника во многих странах основаны на национальных рекомендациях и обычно доступны в справоч-ной и учебной литературе [13,14]. Определение того, какой диетический подход использовать, может быть проблематичным из-за ограниченных научных данных высокого качества и консенсуса в отношении рекомендаций по рациону пациентов с СРК.…”

“…Определение того, какой диетический подход использовать, может быть проблематичным из-за ограниченных научных данных высокого качества и консенсуса в отношении рекомендаций по рациону пациентов с СРК. Долговременные эффекты и безопасность некоторых диет, например таких, как диета со сниженным содержанием ферментируемых олиго-, ди-, моносахаридов и полиолов (fermentable oligosaccharides, disaccharides, monosaccharides and polyols -FODMAP), беспшеничная и безглютеновая диеты (БГД), несмотря на широкое распространение, особенно в Северной Америке и Европе, в настоящее время не доказаны, и статус диет при СРК не установлен и имеет условные рекомендации [14,15]. В систематическом обзоре и метаанализе, посвященном диете при СРК, продемонстрировано, что качество опубликованных исследований о диетических вмешательствах при СРК в целом слабое, доказательства низкого качества и необходимо больше доказательств эффективности диетических вмешательств [16].…”