AGA clinical practice guideline on the pharmacological management of irritable bowel syndrome with constipation

Chang, Lin; Sultan, Shahnaz; Lembo, Anthony; Verne, G. Nicholas; Smalley, Walter; Heidelbaugh, Joel J.

doi:10.1053/j.gastro.2022.04.016

Cited by 163Gastrointestinal motility and disordersMicroscopic ColitisInfant Health and Development

AGA clinical practice guideline on the pharmacological management of irritable bowel syndrome with constipation

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Chang, Lin, Sultan, Shahnaz, Lembo, Anthony, Verne, G. Nicholas, Smalley, Walter, Heidelbaugh, Joel J.·2022·Gastroenterology

DOI 10.1053/j.gastro.2022.04.016

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Abstract

Background & aims Irritable bowel syndrome (IBS) is a common disorder of gut-brain interaction associated with significant disease burden. This American Gastroenterological Association guideline is intended to support practitioners in decisions about the use of medications for the pharmacological management of IBS-C and is an update of a prior technical review and guideline.Methods The Grading of Recommendations Assessment, Development and Evaluation framework was used to assess evidence and make recommendations. The technical review panel prioritized clinical questions and outcomes according to their importance for clinicians and patients and conducted an evidence review of the following agents: tenapanor, plecanatide, linaclotide, tegaserod, lubiprostone, polyethylene glycol laxatives, tricyclic antidepressants, selective serotonin reuptake inhibitors, and antispasmodics. The Guideline Panel reviewed the evidence and used the Evidence-to-Decision Framework to develop recommendations.Conclusions The panel agreed on 9 recommendations for the management of patients with IBS-C. The panel made a strong recommendation for linaclotide (high certainty) and conditional recommendations for tenapanor, plecanatide, tegaserod, and lubiprostone (moderate certainty), polyethylene glycol laxatives, tricyclic antidepressants, and antispasmodics (low certainty). The panel made a conditional recommendation against the use of selective serotonin reuptake inhibitors (low certainty).

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Some probiotics may be beneficial in irritable bowel syndrome (IBS).
“Some probiotics may be bene fi cial in irritable bowel syndrome (IBS), but differences in species and strains used, as well as endpoints reported, have hampered attempts to make speci fi c recommendations as to which should be preferred.”
From Efficacy of Probiotics in Irritable Bowel Syndrome: Systematic Review and Meta-analysis (2023) · cites this paper as [27]
The Limitations and Evidence Gaps section says that an AGA guideline identified evidence gaps concerning probiotics in IBS and called for larger, higher-quality studies. It does not say that some probiotics may be beneficial; searches for probiotic benefits and strain-specific recommendations found no such statement in our copy. (LLM, conf=0.76)
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Self-citation

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Authors: Chang, L., Sultan, S., Lembo, A., Verne, G. N., Smalley, W., & Heidelbaugh, J. J.
Affiliations: University of California, Los Angeles (US)
University of Minnesota (US)
Beth Israel Deaconess Medical Center (US)
University of Tennessee Health Science Center (US)
Vanderbilt University (US)
University of Michigan (US)
ORCID: Chang, Lin
Sultan, Shahnaz
Lembo, Anthony
Verne, G. Nicholas
Venue: Gastroenterology
Publisher: Elsevier BV
Published: 2022-07
Volume: 163
Issue: 1
Pages: 118-136
ISSN: 0016-5085 (ISSN-L)
DOI: 10.1053/j.gastro.2022.04.016
OpenAlex: W4283163096
Cited by: 163
References: 69
Citations by year: 2026: 35 · 2025: 42 · 2024: 39 · 2023: 41 · 2022: 6
FWCI: 27.99
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (am, 354 d)
Locations: Gastroenterology (acceptedVersion)
PubMed (publishedVersion)
Funders: National Institute of Diabetes and Digestive and Kidney Diseases (DK099052, DK118959)
AbbVie
National Institutes of Health
National Heart, Lung, and Blood Institute
Topics: Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
Health Sciences › Medicine › Epidemiology › Microscopic Colitis
Health Sciences › Health Professions › Pharmacy › Infant Health and Development
Keywords: irritable bowel syndrome with constipation, pharmacological management, linaclotide, tenapanor, plecanatide, tegaserod, lubiprostone, tricyclic antidepressants, selective serotonin reuptake inhibitors, antispasmodic agents, gut-brain axis, evidence-based recommendations
MeSH terms: Lubiprostone, Antidepressive Agents, Tricyclic, Constipation, Gastrointestinal Agents, Humans, Parasympatholytics, Polyethylene Glycols, Selective Serotonin Reuptake Inhibitors, Irritable Bowel Syndrome, Laxatives

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AGA clinical practice guideline on the pharmacological management of irritable bowel syndrome with constipation

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