Evidence-based clinical practice guidelines for irritable bowel syndrome 2020

Abstract

Managing irritable bowel syndrome (IBS) has attracted international attention because single-agent therapy rarely relieves bothersome symptoms for all patients. The Japanese Society of Gastroenterology (JSGE) published the first edition of evidence-based clinical practice guidelines for IBS in 2015. Much more evidence has accumulated since then, and new pharmacological agents and non-pharmacological methods have been developed. Here, we report the second edition of the JSGE-IBS guidelines comprising 41 questions including 12 background questions on epidemiology, pathophysiology, and diagnostic criteria, 26 clinical questions on diagnosis and treatment, and 3 questions on future research. For each question, statements with or without recommendations and/or evidence level are given and updated diagnostic and therapeutic algorithms are provided based on new evidence. Algorithms for diagnosis are requisite for patients with chronic abdominal pain or associated symptoms and/or abnormal bowel movement. Colonoscopy is indicated for patients with one or more alarm symptoms/signs, risk factors, and/or abnormal routine examination results. The diagnosis is based on the Rome IV criteria. Step 1 therapy consists of diet therapy, behavioral modification, and gut-targeted pharmacotherapy for 4 weeks. For non-responders, management proceeds to step 2 therapy, which includes a combination of different mechanistic gut-targeted agents and/or psychopharmacological agents and basic psychotherapy for 4 weeks. Step 3 therapy is for non-responders to step 2 and comprises a combination of gut-targeted pharmacotherapy, psychopharmacological treatments, and/or specific psychotherapy. These updated JSGE-IBS guidelines present best practice strategies for IBS patients in Japan and we believe these core strategies can be useful for IBS diagnosis and treatment globally.

Dietary Fibre Intervention for Gut Microbiota, Sleep, and Mental Health in Adults with Irritable Bowel Syndrome: A Scoping Review

“…A narrative review of meta-analyses published in March 2020 [ 110 ] found that four out of five meta-analyses suggested that fibre supplementation could provide significant clinical improvement via the Global Assessment of IBS Symptoms evaluation. This is also reflected in the recent Japanese IBS treatment guidelines suggesting bulking polymers or dietary fibre as an effective IBS treatment ranked as Level A evidence—strong recommendation [ 111 ], although no specific amount was specified.…”

Tapping into 5-HT3 Receptors to Modify Metabolic and Immune Responses

“…5-HT 3 receptors in the gastrointestinal tract modulate physiological responses such as gastric emptying, colonic peristalsis and transit [ 111 , 112 , 113 ]. Thus, 5-HT 3 receptor antagonists are used to treat diarrhea predominant irritable bowel syndrome [ 22 , 114 , 115 ] in addition to chemotherapy-induced nausea and vomiting (CINV) or post-operative vomiting (POV) [ 30 , 116 , 117 ]. Genetic polymorphisms in genes for 5-HT 3 B, 5-HT 3 C, and 5-HT 3 D, predominantly expressed in the gastrointestinal tract and various brain regions [ 13 , 14 ], may contribute to facilitating individual risk predictions ( Table 1 ).…”

Cognitive behavioral treatment for irritable bowel syndrome: a recent literature review

“…), all of which, are related to abnormalities in the functional relationship between the brain and intestine (brain-gut connection). Since IBS is a gastrointestinal psychosomatic disorder that often develops and worsens with stress, it is important to treat it from both the physical and mental aspects [ 4 ]. We shall review recent research on cognitive-behavioral therapy—one of the most widely studied psychological treatments for IBS.…”