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Functional bowel disorders with diarrhoea: Clinical guidelines of the United European Gastroenterology and European Society for Neurogastroenterology and Motility
Abstract
Irritable bowel syndrome with diarrhoea (IBS‐D) and functional diarrhoea (FDr) are the two major functional bowel disorders characterized by diarrhoea. In spite of their high prevalence, IBS‐D and FDr are associated with major uncertainties, especially regarding their optimal diagnostic work‐up and management. A Delphi consensus was performed with experts from 10 European countries who conducted a literature summary and voting process on 31 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation criteria. Consensus (defined as >80% agreement) was reached for all the statements. The panel agreed with the potential overlapping of IBS‐D and FDr. In terms of diagnosis, the consensus supports a symptom‐based approach also with the exclusion of alarm symptoms, recommending the evaluation of full blood count, C‐reactive protein, serology for coeliac disease, and faecal calprotectin, and consideration of diagnosing bile acid diarrhoea. Colonoscopy with random biopsies in both the right and left colon is recommended in patients older than 50 years and in presence of alarm features. Regarding treatment, a strong consensus was achieved for the use of a diet low fermentable oligo‐, di‐, monosaccharides and polyols, gut‐directed psychological therapies, rifaximin, loperamide, and eluxadoline. A weak or conditional recommendation was achieved for antispasmodics, probiotics, tryciclic antidepressants, bile acid sequestrants, 5‐hydroxytryptamine‐3 antagonists (i.e. alosetron, ondansetron, or ramosetron). A multinational group of European experts summarized the current state of consensus on the definition, diagnosis, and management of IBS‐D and FDr.
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In the citing paper
“The United European Gastroenterology (UEG) and the European Society for Neurogastroenterology and Motility (ESNM) do not provide guidelines specifically for IBS treatment.”
From Plant-Derived Treatments for IBS: Clinical Outcomes, Mechanistic Insights, and Their Position in International Guidelines (2026) · cites this paper as [91]
In the citing paper
“Other plant extracts are not mentioned [91].”
From Plant-Derived Treatments for IBS: Clinical Outcomes, Mechanistic Insights, and Their Position in International Guidelines (2026) · cites this paper as [91]
In the citing paper
“However, they published guidelines for functional bowel disorders (FBD) with diarrhea in 2022.”
From Plant-Derived Treatments for IBS: Clinical Outcomes, Mechanistic Insights, and Their Position in International Guidelines (2026) · cites this paper as [91]
In the citing paper
“In these reports, antispasmodic agents are recommended as first-line treatment for patients with IBS-D, with a weak recommendation and low-quality evidence.”
From Plant-Derived Treatments for IBS: Clinical Outcomes, Mechanistic Insights, and Their Position in International Guidelines (2026) · cites this paper as [91]
In the citing paper
“Peppermint oil is listed among the antispasmodic agents, but no specific statement or GRADE rating is provided for it.”
From Plant-Derived Treatments for IBS: Clinical Outcomes, Mechanistic Insights, and Their Position in International Guidelines (2026) · cites this paper as [91]
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Rifaximin Therapy for Patients with Irritable Bowel Syndrome without Constipation
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“Upper gastrointestinal endoscopy with duodenal biopsies should be performed in cases of positive serology in adult patients.(45) Statement 1.”
BackgroundOka, P., Parr, H., Barberio, B., Black, C. J., Savarino, E. V., & Ford, A. C. (2020) · The Lancet Gastroenterology & Hepatology · doi:10.1016/s2468-1253(20)30217-x · Cited by 882
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Self-citationEradication of Small Intestinal Bacterial Overgrowth Reduces Symptoms of Irritable Bowel Syndrome
Pimentel, M., Chow, E. J., & Lin, H. C. (2000) · American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2000.03368.x · Cited by 780
Gut Microbiota in Patients With Irritable Bowel Syndrome—A Systematic Review
Pittayanon, R., Lau, J. T., Yuan, Y., Leontiadis, G. I., Tse, F., Surette, M., & Moayyedi, P. (2019) · Gastroenterology · doi:10.1053/j.gastro.2019.03.049 · Cited by 719
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Cited by
Aziz, Q., Harris, L. A., Goodman, B. P., Simrén, M., & Shin, A. (2025) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2025.02.015 · Cited by 27
Self-citationTao, W., Yu, Y., Tan, D., Huang, X., Huang, J., Lin, C., & Yu, R. (2025) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2025.1603442 · Cited by 9
Pastras, P., Aggeletopoulou, I., Bali, M., & Triantos, C. (2026) · Nutrients · doi:10.3390/nu18020183 · Cited by 1
Metadata
- Authors
- Savarino, E., Zingone, F., Barberio, B., Marasco, G., Akyuz, F., Akpinar, H., Barboi, O., Bodini, G., Bor, S., Chiarioni, G., Cristian, G., Corsetti, M., Di Sabatino, A., Dimitriu, A. M., Drug, V., Dumitrascu, D. L., Ford, A. C., Hauser, G., Nakov, R., Patel, N., Pohl, D., Sfarti, C., Serra, J., Simrén, M., Suciu, A., Tack, J., Toruner, M., Walters, J., Cremon, C., & Barbara, G.
- Affiliations
- Gastroenterology Unit Department of Surgery, Oncology and Gastroenterology University of Padua Padua Italy
- Division of Internal Medicine IRCCS Azienda Ospedaliero‐Universitaria di Bologna Bologna Italy
- Department of Gastroenterology İstanbul University İstanbul School of Medicine İstanbul Turkey
- Department of Internal Medicine Dokuz Eylül University School of Medicine Izmir Turkey
- Department of Gastroenterology ‘Grigore T. Popa’ University of Medicine and Pharmacy Iasi Romania
- Gastrointestinal Unit Department of Internal Medicine University of Genoa Genoa Italy
- Division of Gastroenterology Ege University School of Medicine Izmir Turkey
- Division of Gastroenterology University of Verona Verona Italy
- Fundeni Clinical Institute Center of Gastroenterology and Hepatology Carol Davila University of Medicine and Pharmacy Bucharest Romania
- National Institute for Health Research Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust Nottingham UK
- First Department of Internal Medicine IRCCS San Matteo Hospital Foundation University of Pavia Pavia Italy
- Center of Gastroenterology and Hepatology Fundeni Clinical Institute University of Medicine and Pharmacy Bucharest Romania
- 2nd Department of Internal Medicine ‘Iuliu Hatieganu’ University of Medicine and Farmacy Cluj‐Napoca Romania
- Leeds Gastroenterology Institute Leeds Teaching Hospitals NHS Trust Leeds UK
- Department of Gastroenterology Clinical Hospital Center Rijeka Faculty of Medicine University of Rijeka Rijeka Croatia
- Department of Gastroenterology Tsaritsa Yoanna University Hospital Medical University of Sofia Sofia Bulgaria
- Imperial College Healthcare NHS Trust Institute of Global Health Innovation St Mary's Hospital Campus London UK
- Department of Gastroenterology University Hospital Zurich Zurich Switzerland
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) Badalona Spain
- Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Translational Research Center for Gastrointestinal Disorders University of Leuven Leuven Belgium
- Department of Gastroenterology Ankara University School of Medicine Ankara Turkey
- Division of Digestive Diseases Department of Metabolism, Digestion, and Reproduction Faculty of Medicine Imperial College London London UK
- Venue
- United European Gastroenterology Journal
- Publisher
- Wiley
- Published
- 2022-06-13
- Volume
- 10
- Issue
- 6
- Pages
- 556-584
- ISSN
- 2050-6406
- 2050-6414
- Cited by
- 146
- References
- 44
- Language
- en
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- The paper
- Savarino, E., Zingone, F., Barberio, B., Marasco, G., Akyuz, F., Akpinar, H., Barboi, O., Bodini, G., Bor, S., Chiarioni, G., Cristian, G., Corsetti, M., Di Sabatino, A., Dimitriu, A. M., Drug, V., Dumitrascu, D. L., Ford, A. C., Hauser, G., Nakov, R., . . . Barbara, G. (2022). Functional bowel disorders with diarrhoea: Clinical guidelines of the United European Gastroenterology and European Society for Neurogastroenterology and Motility. United European Gastroenterology Journal. https://doi.org/10.1002/ueg2.12259
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