2025 Seoul Consensus on Clinical Practice Guidelines for Irritable Bowel Syndrome

Abstract

Irritable bowel syndrome (IBS) is a chronic, disabling, and functional bowel disorder that significantly affects social functioning and reduces quality of life and increases social costs. The Korean Society of Neurogastroenterology and Motility published clinical practice guidelines on the management of IBS based on a systematic review of the literature in 2017, and planned to revise these guidelines in light of new evidence on the pathophysiology, diagnosis, and management of IBS. The current revised version of the guidelines is consistent with the previous version and targets adults diagnosed with or suspected of having IBS. These guidelines were developed using a combination of de novo and adaptation methods, with analyses of existing guidelines and discussions within the committee, leading to the identification of key clinical questions. Finally, the guidelines consisted of 22 recommendations, including 3 concerning the definition and risk factors of IBS, 4 regarding diagnostic modalities and strategies, 2 regarding general management, and 13 regarding medical treatment. For each statement, the advantages, disadvantages, and precautions were thoroughly detailed. The modified Delphi method was used to achieve expert consensus to adopt the core recommendations of the guidelines. These guidelines serve as a reference for clinicians (including primary care physicians, general healthcare providers, medical students, residents, and other healthcare professionals) and patients, helping them to make informed decisions regarding IBS management.

Keywords: Diagnosis; Irritable bowel syndrome; Meta-analysis; Practice guideline; Therapeutics.

Figure 1

Suggested diagnostic algorithm for irritable bowel syndrome (IBS).

Figure 2

Suggested therapeutic algorithm for irritable bowel syndrome (IBS). FODMAP, fermentable oligosaccharides, disaccharides, monosaccharides, and polyols; IBS-C, IBS with predominant constipation; PEG, polyethylene glycol; IBS-D, IBS with predominant diarrhea; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; TCAs, tricyclic antidepressants.

Figure 3

The effectiveness of low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) diet for improving irritable bowel syndrome (IBS) symptoms: (A) adequate symptom improvement and (B) change of IBS severity scoring system (IBS-SSS). LFD, low FODMAP diet; M-H, Mantel-Haenszel. *Criteria for symptom improvement: reduction of IBS-SSS ≥ 50 (Bohn 2015, McIntosh 2017, Goyal 2021, Rej 2022), IBS-SSS < 175 (Harvie 2017), 30% decrease of symptom score (Eswaran 2016, Wilson 2020, Staudacher 2012 and 2017, Patcharatrakul 2019, Zhang 2021).

Figure 4

The effectiveness of 5-hydroxytryptamine 3 (5-HT₃) receptor antagonists for improving irritable bowel syndrome (IBS) symptoms: (A) global IBS symptom, (B) abdominal pain and discomfort, and (C) abnormal bowel habits or stool consistency. M-H, Mantel-Haenszel.

Figure 5

The effectiveness of lubiprostone, a chloride channel activator, for improving irritable bowel syndrome symptoms: (A) abdominal pain and (B) bloating. M-H, Mantel-Haenszel.