AGA Clinical Practice Guideline on the pharmacological management of irritable bowel syndrome with diarrhea
Open accessAbstract
Background & aims Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder 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 with predominant diarrhea (IBS-D) 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: eluxadoline, rifaximin, alosetron, loperamide, 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 8 recommendations for the management of patients with IBS-D. The panel made conditional recommendations for eluxadoline, rifaximin, alosetron, (moderate certainty), loperamide (very low certainty), tricyclic antidepressants, and anstispasmodics (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 [26]
The Limitations and Evidence Gaps section says that evidence on probiotics for IBS is insufficient and that larger, higher-quality studies are needed. It does not say that some probiotics may be beneficial; searching for probiotic strains, endpoints, and recommendations yielded no passage establishing that benefit. (LLM, conf=0.72)
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Efficacy of Probiotics in Irritable Bowel Syndrome: Systematic Review and Meta-analysis
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An evidence-based update on the diagnosis and management of irritable bowel syndrome
Black, C. J., & Ford, A. C. (2025) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2025.2455586 · Cited by 27 · see citing works
- Authors
- Lembo, A., Sultan, S., Chang, L., Heidelbaugh, J. J., Smalley, W., & Verne, G. N.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- University of Minnesota (US)
- University of California, Los Angeles (US)
- University of Michigan (US)
- Vanderbilt University (US)
- University of Tennessee Health Science Center (US)
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2022-07
- Volume
- 163
- Issue
- 1
- Pages
- 137-151
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W4283157307
- Cited by
- 192
- References
- 57
- Citations by year
- 2026: 59 · 2025: 51 · 2024: 41 · 2023: 34 · 2022: 7
- FWCI
- 29.18
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Gastroenterology (acceptedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (DK099052, DK118959)
- AbbVie
- National Institutes of Health
- Allergan
- National Heart, Lung, and Blood Institute
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Health Professions › Pharmacy › Infant Health and Development
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Keywords
- irritable bowel syndrome with diarrhea, pharmacological management, eluxadoline, rifaximin, alosetron, loperamide, tricyclic antidepressants, selective serotonin reuptake inhibitors, antispasmodic agents, functional gastrointestinal disorders, drug recommendation
- MeSH terms
- Rifaximin, Antidepressive Agents, Tricyclic, Diarrhea, Gastrointestinal Agents, Humans, Loperamide, Selective Serotonin Reuptake Inhibitors, Irritable Bowel Syndrome
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