BETHESDA, Md -- December 18, 2008 -- The American College of Gastroenterology (ACG) has today published a new evidence-based systematic review on the management of Irritable Bowel Syndrome (IBS) as a supplement to the January 2009 issue of The American Journal of Gastroenterology.
"For the gastroenterologist seeing patients with IBS, the new ACG recommendations specify whether or not the range of potential therapies are better than placebo for resolving IBS symptoms," said Lawrence J. Brandt, MD, ACG IBS Task Force, Bethesda, Maryland.
"The College's graded recommendations on IBS take into account the quality of the evidence, such as the strength of study design, and the magnitude of benefit of different treatments. The benefits of treatment must be balanced against any potential risks."
The College's new recommendations include expert assessments of traditional therapies for IBS, as well as a range of new treatments, including evidence on probiotics; rifaximin; antidepressants; antispasmodics and peppermint oil; fiber, bulking agents and laxatives; anti-diarrhoeals, including loperamide; alosetron; tegaserod; lubiprostone; psychologic therapies; herbal preparations and acupuncture.
The evidence-based review also includes new recommendations about the routine use of diagnostic tests for patients presenting with IBS symptoms, as well as food allergy testing and diet in IBS.
Highlights of ACG's new recommendations on IBS therapies include:
· Trials suggest psyllium, fiber, certain antispasmodics, and peppermint oil are effective in IBS patients although the quality of the evidence is poor.
· Evidence suggests that some probiotics may be effective in reducing overall IBS symptoms but more data are needed.
· Anti-diarrhoeals reduce the frequency of stools but do not affect the overall symptoms of IBS.
· 5HT 3 antagonists are efficacious in IBS patients with diarrhoea and the quality of evidence is good. Patients need to be carefully selected, however, because potentially serious side effects include constipation and colon ischaemia.
· 5HT 4 agonists are modestly effective in IBS patients with constipation and the quality of evidence is good although the possible risk of cardiovascular events associated with these agents may limit their utility.
· Tricyclic anti-depressants and selective serotonin reuptake inhibitors have been shown to be effective in IBS patients of all subtypes. The trials generally are of good quality but the limited number of patients included in trials implies that further evidence could change the confidence in the estimate of effect and therefore the quality of evidence was graded as moderate.
· Non-absorbable antibiotics are effective, particularly in diarrhoea-predominant IBS.
· Lubiprostone is efficacious in constipation-predominant IBS with a moderate quality of evidence.
Recommendations on diagnostic testing in IBS include:
· Routine diagnostic testing with complete blood count, serum chemistries, thyroid function studies, stool for ova and parasites, and abdominal imaging should not be routinely performed in patients with typical IBS symptoms and no alarm features.
· Routine serologic screening for celiac sprue should be pursued in patients with diarrhoea predominant IBS and the mixed type of IBS. Lactose breath testing can be considered when lactose maldigestion remains a concern despite dietary modification.
· Currently, there are insufficient data to recommend breath testing for small intestinal bacterial overgrowth in IBS patients.
· Because of the low pre-test probability of Crohn's disease, ulcerative colitis, and colonic neoplasia, routine colonic imaging is not recommended in patients aged <50 years with typical IBS symptoms and no alarm features.
· Colonoscopic imaging should be performed in IBS patients with alarm features to rule out organic diseases and in those aged >50 years for the purpose of colorectal cancer screening.
The ACG Evidence-Based Systematic Review on IBS can be accessed here: http://www.acg.gi.org/media/releases/ajg_ibs_supp_0109.pdf
SOURCE: American College of Gastroenterology
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