Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Apr;2(1):6-29.
doi: 10.1093/jcag/gwy071. Epub 2019 Jan 17.

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

Paul Moayyedi  1 , Christopher N Andrews  2 , Glenda MacQueen  3 , Christina Korownyk  4 , Megan Marsiglio  5 , Lesley Graff  6 , Brent Kvern  7 , Adriana Lazarescu  8 , Louis Liu  9 , William G Paterson  10 , Sacha Sidani  1 , Stephen Vanner  10
Affiliations

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

Paul Moayyedi et al. J Can Assoc Gastroenterol. 2019 Apr.

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.

Keywords: Clinical practice guidelines; Constipation; Diarrhea; Irritable bowel syndrome.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Proportion of subjects with lactose intolerance in IBS patients and healthy volunteers
Figure 2.
Figure 2.
Proportion of SIBO in IBS patients and healthy volunteers
Figure 3.
Figure 3.
Forest plot of RR of IBS not improving in RCTs of peppermint oil versus placebo in IBS
Figure 4.
Figure 4.
Forest plot of RR of IBS not improving in RCTs of loperamide versus placebo in IBS-D or IBS-M
Figure 5.
Figure 5.
Forest plot of RR of IBS not improving in RCTs of eluxadoline versus placebo in IBS-D
Figure 6.
Figure 6.
Forest plot of RR of IBS not improving in RCTs of lubiprostone versus placebo in IBS-C
Figure 7.
Figure 7.
Forest plot of RR of IBS not improving in RCTs of linaclotide versus placebo in IBS-C
Figure 8.
Figure 8.
Consensus guided algorithm for the management of IBS. *Reduce age threshold to ≥45 years if female with IBS-D; †if bloating/pain main feature; §if pain main feature.
See this image and copyright information in PMC

References

    1. Lacy BE, Mearin F, Chang L, et al. Bowel disorders. Gastroenterology 2016;150:1393–407.e5. - PubMed
    1. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: A meta-analysis. Clin Gastroenterol Hepatol 2012;10(7):712–721.e4. - PubMed
    1. Sperber AD, Dumitrascu D, Fukudo S, et al. The global prevalence of IBS in adults remains elusive due to the heterogeneity of studies: A Rome Foundation working team literature review. Gut 2017;66(6):1075–82. - PubMed
    1. Thompson WG, Irvine EJ, Pare P, et al. Functional gastrointestinal disorders in Canada: First population-based survey using Rome II criteria with suggestions for improving the questionnaire. Dig Dis Sci 2002;47(1):225–35. - PubMed
    1. Palsson OS, van Tilburg MA, Simren M, et al. Population prevalence of Rome IV and Rome III irritable bowel syndrome (IBS) in the United States (US), Canada and the United Kingdom (UK) [Abstract Mo1642]. Gastroenterology 2016;150:S739–40.

LinkOut - more resources