The DOI matches its Crossref record; 311 of the 311 references it cites were found in a registry or an index; 161 of the 282 sources its claims cite were checked for support.
British Society of Gastroenterology guidelines on the management of irritable bowel syndrome
Open accessAbstract
Irritable bowel syndrome (IBS) remains one of the most common gastrointestinal disorders seen by clinicians in both primary and secondary care. Since publication of the last British Society of Gastroenterology (BSG) guideline in 2007, substantial advances have been made in understanding its complex pathophysiology, resulting in its re-classification as a disorder of gut-brain interaction, rather than a functional gastrointestinal disorder. Moreover, there has been a considerable amount of new evidence published concerning the diagnosis, investigation and management of IBS. The primary aim of this guideline, commissioned by the BSG, is to review and summarise the current evidence to inform and guide clinical practice, by providing a practical framework for evidence-based management of patients. One of the strengths of this guideline is that the recommendations for treatment are based on evidence derived from a comprehensive search of the medical literature, which was used to inform an update of a series of trial-based and network meta-analyses assessing the efficacy of dietary, pharmacological and psychological therapies in treating IBS. Specific recommendations have been made according to the Grading of Recommendations Assessment, Development and Evaluation system, summarising both the strength of the recommendations and the overall quality of evidence. Finally, this guideline identifies novel treatments that are in development, as well as highlighting areas of unmet need for future research.
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Claims the paper makes
73 Partly supported · 62 Supported · 47 No full text of the sources · 27 No basis given · 21 Own interpretation · 20 Sources not found · 10 Supported so far · 10 Own result · 9 Own method · 5 Couldn’t confirm · 4 Not checked yet · 2 Not supported · 1 Mixed support · accuracy not yet measured
At least one cited source doesn’t support this claim or points to a different paper, and none confirmed it — see the verdicts below.
In the paper
“The effect of FODMAP reintroduction to tolerance on IBS symptoms is therefore unclear, although there have been open-label studies reporting the long-term efficacy of an adapted low FODMAP diet ranges somewhere between 50% and 60%.177 203”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Fibre and dietary therapies
What the sources say
- Disputedcites [177] sourceExperimental — accuracy not yet measured
The Introduction says evidence on reintroduction was previously unavailable, but this paper then studies it. Its Discussion reports that reintroduction to tolerance improved fiber intake without significant worsening of IBS symptoms; the Results report that reduced symptom severity was sustained at six months. Thus the paper does not present symptom outcomes after reintroduction as unclear. (LLM, conf=0.86)
Checked by a reasoning model — may be wrong.
- Not checked — no full text of the sourcecites [203] O"Keeffe, 2018, Long-Term impact of the low-FODMAP diet on gastrointestinal symptoms, dietary intake, patient acceptability, and healthcare utilization in irritable bowel syndrome, Neurogastroenterol Motil source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Disputed
Some cited sources support this claim and some don’t — read each source’s verdict below.
In the paper
“Linaclotide 290 μg once a day ranked first across all end points, including abdominal bloating (online supplemental figure 14-16 and online supplemental figure 19)”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used second line for the treatment of IBS-C
What the sources say
- Partly supportedcites [154] sourceExperimental — accuracy not yet measured
The Results (p. 6) rank linaclotide 290 μg once daily first for the study’s efficacy endpoint, and the Discussion (p. 7) confirms that efficacy ranking. The Methods (p. 6) define that endpoint using abdominal pain and bowel movements; our copy does not report a ranking for abdominal bloating or establish that linaclotide ranked first across all endpoints. (LLM, conf=0.88)
- Disputedcites [155] sourceExperimental — accuracy not yet measured
The Discussion (p. 21) ranks linaclotide 290 μg once daily first for global symptoms, abdominal pain response, and complete spontaneous bowel movement response, but ranks tenapanor 50 mg twice daily first for bloating response. The Abstract (p. 7) makes the same distinction, contradicting the claim that linaclotide ranked first across all endpoints, including bloating. (LLM, conf=0.94)
Checked by a reasoning model — may be wrong.
plainn = 638- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Modulating activity of the brain regions responsible for visceral pain using various therapies has been shown to improve IBS symptomatology.[36][37][38]”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Central nervous system and autonomic nervous system modulation
What the sources say
- Partly supportedcites [36] sourceExperimental — accuracy not yet measured
The Background & Aims and Correlation of rCBF Changes and IBS Symptom Improvement sections report that alosetron improved IBS symptoms and that decreased activity in the amygdala, ventral striatum, and dorsal pons correlated with reduced abdominal pain. But the study tested one therapy and found reduced activity in central autonomic regions, not in areas activated by pain; it suggests rather than establishes that the brain changes caused the improvement. Page numbers were not available in our copy. (LLM, conf=0.88)
- Partly supportedcites [37] sourceExperimental — accuracy not yet measured
The Discussion reports that amitriptyline reduced pain-related brain activation during mental stress in patients with IBS, but describes symptom improvement through this mechanism as a postulate. The Symptom rating section found a nonsignificant preference for amitriptyline (p = 0.06) and a nonsignificant difference in pain ratings (p = 0.2). This single-drug study does not establish that various therapies improve IBS symptoms by modulating brain activity. (LLM, conf=0.88)
- Partly supportedcites [38] sourceExperimental — accuracy not yet measured
The Abstract and Conclusion report that cognitive therapy improved IBS symptoms alongside reduced activity in brain regions involved in pain perception. The paper studied one therapy and describes the neural changes as associated with improvement, not as proof that modulating those regions caused the improvement or that various therapies do so. (LLM, conf=0.88)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“This feature makes the Rome IV criteria potentially more specific than Rome III.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > CLASSIFICATION AND DIAGNOSTIC CRITERIA
What the sources say
- Partly supportedcites [9] sourceExperimental — accuracy not yet measured
In the IBS sensitivity analysis (page unavailable), the paper says Rome IV uses the more restrictive requirement of abdominal pain rather than Rome III’s abdominal pain or discomfort. It also estimates Rome IV specificity in a population survey, but the passages do not compare Rome IV and Rome III specificity, so they do not establish that Rome IV is more specific. (LLM, conf=0.78)
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Some patients with IBS have compromised central inhibitory regulation of visceral and somatic stimuli.35”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Central nervous system and autonomic nervous system modulation
What the sources say
- Partly supportedcites [35] sourceExperimental — accuracy not yet measured
The Discussion concludes that IBS patients showed compromised inhibitory regulation of somatic pain stimuli. It also reports an earlier finding of impaired inhibition during visceral stimulation, but cautions that distraction, hypervigilance, or peripheral gut sensitization could explain that finding; this paper therefore does not establish compromised central inhibition of visceral stimuli. (LLM, conf=0.86)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Between 20% and 60% of patients with IBS have enhanced visceral perception to various physiological stimuli (eg, mechanical or electrical).41”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Altered visceral perception
What the sources say
- Partly supportedcites [41] sourceExperimental — accuracy not yet measured
The Introduction reports enhanced visceral perception in some IBS patients: 40–60% had lowered pain thresholds and 16–37% had increased sensory ratings to balloon distension. This supports the general point and a mechanical stimulus, but not the stated 20% lower bound across those measures or the example of electrical stimulation. (LLM, conf=0.86)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Altered activation of brain regions responsible for cognitive processing and emotional and autonomic responses to visceral and somatic stimuli are seen in IBS, consistent with visceral hypersensitivity, hypervigilance and symptom-related anxiety.34”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Central nervous system and autonomic nervous system modulation
What the sources say
- Partly supportedcites [34] Black CJ , Yiannakou Y , Houghton LA . Anxiety‐related factors associated with symptom severity in irritable bowel syndrome. Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society 2020:e13872. sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Due to the uncertainty surrounding pooled estimates of global prevalence, and the apparent variation in prevalence between countries in separate studies, a subsequent Rome Foundation global survey has quantified the prevalence of IBS, among 73 000 adults in 33 different countries simultaneously, using both the Rome III and IV criteria.19”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > EPIDEMIOLOGY
What the sources say
- Partly supportedcites [19] sourceExperimental — accuracy not yet measured
The Methods and Results report a survey in 33 countries completed by 73,076 respondents, and the paper compares IBS prevalence under Rome III and Rome IV criteria. However, the FGID case definitions section says Rome III questions were included only in all nine household-survey countries and 14 of the 26 Internet-survey countries; the claim implies both criteria were used across the full survey. (LLM, conf=0.88)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Genetics, and epigenetic changes, infection and early adverse life events may predispose an individual to developing IBS, [25][26][27][28]”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > PATHOPHYSIOLOGY
What the sources say
- Not checked — no full text of the sourcecites [25] source
- Partly supportedcites [26] sourceExperimental — accuracy not yet measured
The Abstract says family and twin studies suggest a genetic basis for IBS. The section “What in the Current State of Knowledge Is Lacking?” identifies infection and abuse as possible shared risk factors needing further study, but does not establish them as predisposing factors. No passage in our copy supports the claim about epigenetic changes. (LLM, conf=0.85)
- Not checked — no full text of the sourcecites [27] source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“up to 50% of patients who believe they have IBS will no longer meet criteria for the condition.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > EPIDEMIOLOGY
What the sources say
- Partly supportedcites [21] sourceExperimental — accuracy not yet measured
The Introduction says Rome IV tightened the symptom requirements, and the Results report that some patients meeting Rome III did not meet Rome IV. But the paper does not report that up to 50% of patients who believe they have IBS lose eligibility; it studied a secondary-care referral population, not patients identified by that belief. (LLM, conf=0.84)
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
- It may state two separate claims as one. 121
- Probably not a substantial claim. 30
At least one cited source doesn’t support this claim or points to a different paper, and none confirmed it — see the verdicts below.
In the paper
“Alosetron was withdrawn from the market in 2001 due to reports of ischaemic colitis. 234 However, it was reintroduced in the USA via a risk evaluation and mitigation strategy, at a lower dose of 0.5 mg two times per day, for women with severe IBS-D.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used second line for the treatment of IBS-D
What the sources say
- Disputedcites [234] sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 1 partially supported, 1 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Checked by a reasoning model — may be wrong.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Disputed
Every source the paper cites for this claim was checked and supports it.
In the paper
“Symptoms are generated by interoceptive signals from the gut, and memories of such signals, and are modulated by emotional (anxiety, depression), cognitive (attention, beliefs and expectation) and motivational factors.33”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Central nervous system and autonomic nervous system modulation
What the sources say
- Supportedcites [33] source
The Introduction states that subjective symptom reports in disorders of brain–gut interaction are generated in part from GI interoceptive signals and memories of them, and are modulated by emotional, cognitive and motivational factors. Its discussion of IBS-related threat appraisal and expectations also supports the citing sentence’s reference to beliefs. (LLM, conf=0.90)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“IBS is a disorder of altered bidirectional communication between the gut and brain (via the gut-brain axis), and has a biopsychosocial aetiology.32”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > PATHOPHYSIOLOGY
What the sources say
- Supportedcites [32] source
The Special Issue Editors section classifies IBS as a functional gastrointestinal disorder and describes these disorders as gut–brain interactions understood through a biopsychosocial model. It also describes altered gut signaling and central nervous system modulation of gut function, supporting the paraphrase about communication in both directions. The supplied copy gives no page number for these passages. (LLM, conf=0.88)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“resulting in its re-classification as a disorder of gut-brain interaction, rather than a functional gastrointestinal disorder.”
- Also stated in: § CLASSIFICATION AND DIAGNOSTIC CRITERIA · plain
“The Rome IV process also redefined IBS as a disorder of gut-brain interaction, in recognition of the complex interplay of biological, psychological, and social factors underpinning the condition.”
- Also stated in: § PATHOPHYSIOLOGY · plain
“As a result, it has been re-termed a disorder of gut-brain interaction.32”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Abstract
What the sources say
- Partly supportedcites [32] sourceExperimental — accuracy not yet measured
The Special Issue Editors section says functional GI disorders are “better defined as Disorders of Gut-Brain Interaction,” supporting the terminology used for IBS. But its Table 1 still lists IBS under “Functional Gastrointestinal Disorders,” so the source does not support treating the two labels as mutually exclusive. (LLM, conf=0.88)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Also stated in: § CLASSIFICATION AND DIAGNOSTIC CRITERIA · plain
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Reduced vagal tone may be caused by stress, and impacts on gut motility and sensitivity, and peripheral inflammation and gut permeability.40”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Central nervous system and autonomic nervous system modulation
What the sources say
- Partly supportedcites [40] Bonaz, 2018, The vagus nerve at the interface of the microbiota-gut-brain axis, Front Neurosci sourceExperimental — accuracy not yet measured
The Introduction and “Stress, vagus nerve, and the microbiota” section say stress inhibits the vagus nerve and blunts its anti-inflammatory action. “Brain to gut interactions” says low vagal activity increases intestinal permeability and promotes systemic inflammation. The copy does not clearly establish the additional claim that reduced vagal tone affects gut motility and sensitivity. (LLM, conf=0.84)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Approximately 20% of patients with IBS are viscerally hyposensitive or insensitive to mechanical distension, more commonly those with IBS-C than IBS-D, with one study suggesting that the degree of insensitivity correlated with abdominal distension (ie, a true physical increase in abdominal girth).43”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Altered visceral perception
What the sources say
- Supportedcites [43] source
The Hyper-vs Normo-vs Hyposensitive Patients section reports that 22% of the IBS patients studied were hyposensitive to rectal distention, including 28% of IBS-C patients and 14% of IBS-D patients. The Discussion also says that patients with higher pain thresholds distended more during the day, supporting the additional point in the citing sentence. Page numbers are not available in the supplied passages. (LLM, conf=0.93)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Colonic transit time correlates inversely with stool consistency and, to a lesser extent, with stool frequency.45”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Transit and motility
What the sources say
- Supportedcites [45] source
The ‘Total and segmental transit time, bowel habits, and GI symptoms’ section reports negative correlations between total colonic transit time and both stool form (ρ = −0.41) and stool frequency (ρ = −0.37) in patients with IBS. The discussion also describes stool frequency as a less reliable marker of transit than stool form. Page numbers were not supplied in the copy. (LLM, conf=0.92)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“The severity and frequency of abdominal pain correlates with the presence of activated mast cells in close proximity to nerve endings in the gut mucosa in some studies, 56 but in others mast cell proliferation associates with a reduction, 57 or no change, 58 in visceral sensitivity.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Immune regulation, inflammation and epithelial permeability
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
Every source the paper cites for this claim was checked and supports it.
In the paper
“There is some evidence for epigenetic changes in IBS, including alterations in DNA methylation, and various miRNAs appear to be associated with increased visceral sensitivity and permeability.80”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Genetics and epigenetics
What the sources say
- Supportedcites [80] Mahurkar-Joshi, 2020, Epigenetic mechanisms in irritable bowel syndrome, Front Psychiatry source
The Abstract describes emerging evidence of DNA methylation changes in IBS models and patients, and miRNAs associated with increased visceral sensitivity and intestinal permeability. The DNA Methylation and MicroRNA sections provide examples of those associations. (LLM, conf=0.95)
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Nevertheless, lower gastrointestinal symptoms frequently prompt people to present to primary care, 81 accounting for approximately 1 in 12 of all consultations.82”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > PRESENTATION OF IBS, DIAGNOSIS AND MANAGEMENT IN PRIMARY CARE Overview
What the sources say
- Could not verifycites [81] sourceExperimental — accuracy not yet measured
Citation 82 is attached to the estimate that lower gastrointestinal symptoms account for approximately 1 in 12 primary-care consultations. The Discussion instead reports that IBS or IBS-related symptoms account for approximately 7.5% of outpatient attendances across all specialties; the Introduction describes a primary-care burden but gives no proportion of all primary-care consultations. Searches for the one-in-twelve estimate and a primary-care consultation percentage found no supporting passage. (LLM, conf=0.75)
- Partly supportedcites [82] sourceExperimental — accuracy not yet measured
The Discussion states that gastrointestinal problems account for about one in 12 primary-care consultations. The Screening and Demographics section likewise reports gastrointestinal complaints in 8.2% of screened patients. Neither passage limits that figure to lower gastrointestinal symptoms, so the claim is narrower than the source supports. (LLM, conf=0.87)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Could not verify
Every source the paper cites for this claim was checked and supports it.
In the paper
“whereas abdominal distension (the physical increase in abdominal girth, rather than the sensation of bloating) correlates with oro-caecal and colonic transit times, and inversely with stool consistency.46”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Transit and motility
What the sources say
- Supportedcites [46] source
The Correlations section reports that, in patients with IBS-C, abdominal distension correlated directly with orocecal and colonic transit times and inversely with Bristol Stool Score. The inverse stool-score correlation had P = 0.07, so that finding should not be read as statistically significant. (LLM, conf=0.90)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In a mouse model, bacterial infection led to an increase in intestinal permeability, which appeared to allow previously tolerated food antigens to activate a localised host immune response in the gastrointestinal tract, via IgE, leading to histamine release, altered motility and visceral hypersensitivity.73”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > The microbiome
What the sources say
- Partly supportedcites [73] sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Changes in gastrointestinal motility may be influenced by alterations in serotonin (5-Hydroxytryptamine (5-HT)) metabolism, 49 with high levels reported in patients with IBS-D, and low levels in IBS-C.50”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Transit and motility
What the sources say
- Not checked — no full text of the sourcecites [49] source
- Supportedcites [50] source
Citation 50 is attached to the comparison of serotonin levels in IBS-D and IBS-C. The Platelet-Depleted Plasma 5-HT Concentrations section (page not available) reports elevated plasma 5-HT in IBS-D and lower post-meal levels in IBS-C than in healthy volunteers and IBS-D patients. The distinction is condition-specific: fasting levels in IBS-C did not differ from healthy volunteers. (LLM, conf=0.90)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Functional gastrointestinal disorders, such as IBS, are by far the most common diagnosis, but symptoms can be difficult to assess and the possibility of colorectal cancer or inflammatory bowel disease (IBD) may create diagnostic uncertainty for clinicians, and anxiety for patients.83”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > PRESENTATION OF IBS, DIAGNOSIS AND MANAGEMENT IN PRIMARY CARE Overview
What the sources say
- Partly supportedcites [83] sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“General practitioners provide the majority of long-term medical care for people with IBS, referring only a minority of patients to specialist clinics.86”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > PRESENTATION OF IBS, DIAGNOSIS AND MANAGEMENT IN PRIMARY CARE Overview
What the sources say
- Partly supportedcites [86] sourceExperimental — accuracy not yet measured
The Methods (Description of CBT interventions and TAU; page unavailable) describe usual GP or consultant follow-up, supporting that GPs provide ongoing care for some patients with IBS. The paper does not establish that GPs provide the majority of long-term care or that only a minority of patients are referred to specialist clinics. (LLM, conf=0.83)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Interleukin-10 mRNA expression and protein levels are consistently reduced in the mucosa and/or peripheral circulation, in patients with IBS-D and PI-IBS, and associate with comorbid anxiety or depression.59”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Immune regulation, inflammation and epithelial permeability
What the sources say
- Partly supportedcites [59] sourceExperimental — accuracy not yet measured
The Results sections comparing IBS-D patients with controls and comparing patients with and without anxiety-depression report lower IL-10 levels in blood and sigmoid colon mucosa. The Methods describe protein-level assays and immunohistochemistry, not mRNA measurement; the paper does not report findings for PI-IBS. No page numbers are available in our copy. (LLM, conf=0.90)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“They may also trigger bowel symptoms as they produce short chain fatty acids, which lower colonic pH.202”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Fibre and dietary therapies
What the sources say
- Partly supportedcites [202] Spiller, 2021, Impact of diet on symptoms of the irritable bowel syndrome, Nutrients sourceExperimental — accuracy not yet measured
Section 5 links FODMAP fermentation to bowel symptoms and suggests that short-chain fatty acids could mediate mast-cell activation. But it attributes the fall in pH to accumulated lactate, not to short-chain fatty acids, so the claimed pH mechanism is not supported. (LLM, conf=0.88)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Patients reporting adverse food reactions experience more severe gastrointestinal symptoms, associated subjective health complaints of musculoskeletal pains and chronic fatigue and reduced quality of life, compared with those without food sensitivities.[189][190][191]”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Fibre and dietary therapies
What the sources say
- Not checked — no full text of the sourcecites [189] source
- Not checked — no full text of the sourcecites [190] source
- Partly supportedcites [191] sourceExperimental — accuracy not yet measured
The Discussion reports that many patients with perceived food hypersensitivity had musculoskeletal pain and chronic fatigue in addition to IBS, and the Conclusions describe these as prevalent comorbidities. However, the study enrolled patients with perceived food hypersensitivity only; it does not establish that their symptoms were more severe, or their quality of life lower, than in people without food sensitivities. (LLM, conf=0.88)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Evidence suggests that 2 minutes of active listening at the beginning of a consultation gives the patient the feeling of having being listened to, 109 and therefore having confidence in subsequent decisions around their care.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > CLINICAL HISTORY AND INVESTIGATION IN SECONDARY CARE The first consultation in secondary care
What the sources say
- Partly supportedcites [109] sourceExperimental — accuracy not yet measured
The Participants, methods, and results section reports that doctors used active-listening techniques and that 78% of patients finished their initial statement within two minutes. The paper does not report whether patients felt listened to or had greater confidence in subsequent care decisions; it measured talking time, not those perceptions. (LLM, conf=0.85)
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“although the diagnostic performance of alarm symptoms or signs is modest, 122 and up to 80% of patients with IBS in primary and secondary care will report at least one alarm symptom.123”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Investigations in secondary care
What the sources say
- Not checked — no full text of the sourcecites [122] source
- Partly supportedcites [123] sourceExperimental — accuracy not yet measured
The citation is attached to the prevalence claim, not the preceding statement about diagnostic performance. The Gastroenterologists vs. primary care section (p. 6) reports that 84.3% of patients with a clinical IBS diagnosis in the combined primary-care and gastroenterology sample reported a red flag. This supports the general point, but the reported figure exceeds the claimed 'up to 80%' bound. (LLM, conf=0.84)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The yield of colonoscopy in patients with IBS is extremely low, 125 and there is no evidence of reassurance being derived by patients from a normal examination.126”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Investigations in secondary care
What the sources say
- Partly supportedcites [125] sourceExperimental — accuracy not yet measured
The Discussion reports that colonoscopy did not alter the IBS diagnosis in 457 of 466 patients (98.1%), supporting the claim of low diagnostic yield. The study included patients with non-constipated IBS and no warning signs, so it does not establish the yield for all patients with IBS. The reassurance clause is attached to a different citation and is not assessed here. (LLM, conf=0.85)
- Not checked — no full text of the sourcecites [126] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“They increase small intestinal water volume and colonic gas production and, in those with visceral hypersensitivity, induce gastrointestinal symptoms.201”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Fibre and dietary therapies
What the sources say
- Supportedcites [201] source
The Secondary endpoints section reports increased small-bowel water after fructose and increased colonic gas after inulin, compared with glucose. The Discussion attributes carbohydrate-related symptoms in patients with IBS to visceral hypersensitivity rather than greater gas production in those who develop symptoms. The paper thus supports the claim about these effects of FODMAPs, without implying that every FODMAP produces both effects. (LLM, conf=0.91)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Studies using small intestinal aspiration, considered the gold standard for diagnosing small intestinal bacterial overgrowth, have not demonstrated an increased prevalence of the condition in suspected IBS, 143 and the lactulose breath test correlates poorly with small intestinal aspiration.144”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Investigations in secondary care
What the sources say
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“For example, IgG antibodies to yeast were reported in 87% of patients yet are rarely responsible for symptoms following dietary rechallenges.195 196”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Fibre and dietary therapies
What the sources say
- Partly supportedcites [195] sourceExperimental — accuracy not yet measured
Table 2 (Discussion; page not provided) lists yeast among the foods excluded for 86.7% of the treatment group, consistent with the rounded 87% figure, but it does not establish that percentage for all patients. The Reintroduction of eliminated foods section reports symptoms after foods were reintroduced as a group; it does not report yeast-specific rechallenge results or say yeast was rarely responsible for symptoms. (LLM, conf=0.88)
- Not matchedcites [196] Hunter, 2005, Food elimination in IBS: the case for IgG testing remains doubtful, Gut
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“IBS is one of the most common disorders that gastroenterologists deal with, accounting for at least 10% of consultations in the outpatient clinic.105”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > CLINICAL HISTORY AND INVESTIGATION IN SECONDARY CARE The first consultation in secondary care
What the sources say
- Partly supportedcites [105] sourceExperimental — accuracy not yet measured
The Results report IBS in 62 of 613 patients (10.1%), and the Discussion identifies it as one of the commonest functional gastrointestinal disorders seen. The study counted consecutive new referrals to one luminal gastroenterology clinic, not all outpatient consultations, including follow-up visits. (LLM, conf=0.83)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“including previous acute enteric infection, present in approximately 10% of people with IBS, 112”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > CLINICAL HISTORY AND INVESTIGATION IN SECONDARY CARE The first consultation in secondary care
What the sources say
- Supportedcites [112] source
The Diagnosis of PI-IBS section reports that 1004 of 7552 people with IBS (13.3%) met the study’s criteria for post-infectious IBS. The Discussion also reports a conservative estimate of 9%. Both support the claim’s approximate 10% figure, though the study’s own internet-survey estimate was 13.3%. (LLM, conf=0.90)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The presence of bloating is not required to fulfil the Rome IV criteria but, if present, is highly suggestive of IBS, and is often accompanied by visible abdominal distension.114”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > CLINICAL HISTORY AND INVESTIGATION IN SECONDARY CARE The first consultation in secondary care
What the sources say
- Partly supportedcites [114] sourceExperimental — accuracy not yet measured
The Results (p. 1) report greater bloating in IBS patients than controls and distention in 48% of patients; the Discussion (p. 7) notes that some IBS patients do not experience bloating. However, the study used Rome II criteria, not Rome IV, and does not establish that bloating is highly suggestive of IBS; seven of 20 healthy volunteers also reported bloating (p. 3). (LLM, conf=0.88)
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“However, this effect was limited to soluble fibre, such as ispaghula (RR 0.83; 95% CI 0.73 to 0.94), but not insoluble fibre, like wheat bran, which may exacerbate abdominal pain and bloating.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Fibre and dietary therapies
What the sources say
- Could not verifycites [158] sourceExperimental — accuracy not yet measured
The ‘Efficacy and Safety of Prebiotics in IBS’ section (page unavailable) discusses fructooligosaccharides and trans-galactooligosaccharides, not a comparison of soluble and insoluble fibre. Searches for ispaghula, wheat bran, soluble fibre, and the stated RR and confidence interval found no passage supporting the claim or its statement about worsened pain and bloating. (LLM, conf=0.77)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“An empathic approach can improve quality of life and symptoms, 110 reduce healthcare visits and enhance adherence to treatment.108 111”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > CLINICAL HISTORY AND INVESTIGATION IN SECONDARY CARE The first consultation in secondary care
What the sources say
- Not checked — no full text of the sourcecites [108] source
- Partly supportedcites [110] sourceExperimental — accuracy not yet measured
The Discussion (page unavailable) says that helping patients make sense of their IBS could improve quality of life, and the paper links a mutually understanding doctor–patient relationship with maintaining quality of life. It does not report that an empathic approach improves symptoms, reduces healthcare visits, or increases treatment adherence; its exploratory findings also do not establish that the approach causes improvement. (LLM, conf=0.88)
- Not checked — no full text of the sourcecites [111] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“All patients should be advised of the potential benefits of regular exercise, as there is some evidence from RCTs that this can be beneficial, 150 151 particularly for constipation, 150 with beneficial effects still apparent at 5 years in one trial.152”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > TREATMENT OF IBS General overview
What the sources say
- Not matchedcites 150 151
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites [150] source
- Supportedcites [152] source
Citation 152 is attached to the claim that benefits remained apparent at five years, not to the separate constipation claim. The Discussion reports positive clinical effects after approximately five years of follow-up in patients who had undergone an intervention to increase physical activity. (LLM, conf=0.93)
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Symptoms of BAD can mimic IBS-D, with between one-in-three and one-in-four patients with suspected IBS-D having an abnormal SeHCAT retention, 133 134 and response rates to a bile acid sequestrant are higher at retentions of <10% or <5%.135”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Investigations in secondary care
What the sources say
- Not matchedcites 133 134
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Supportedcites [135] source
Citation 135 is attached to the treatment-response claim. The Abstract reports that response to colestyramine, a bile acid binder, rose from 70% at SeHCAT retention <15% to 80% at <10% and 96% at <5%. (LLM, conf=0.94)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Patients meeting these criteria were 21 times more likely to have IBS-C than to not have IBS-C, and 11 times more likely to have IBS-M than to not have IBS-M after limited diagnostic workup.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Investigations in secondary care
What the sources say
- Partly supportedcites [21] sourceExperimental — accuracy not yet measured
The Validation of the Rome IV Criteria for IBS section reports positive likelihood ratios of 25.7 for IBS with constipation and 10.6 for IBS with mixed bowel habits; the latter is approximately 11, but the former is not 21. The Introduction’s figure of 21 concerns IBS overall in an earlier validation study, not IBS-C in this study. The Investigative Work-up section describes a standardised but non-exhaustive work-up. (LLM, conf=0.89)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Overall, adverse events with peppermint oil were no more common than placebo, 160 although patients can report gastro-oesophageal reflux symptoms due to its effects on the lower oesophageal sphincter.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used first line for IBS
What the sources say
- Supportedcites [160] source
The Quality of evidence: Low section reports that pooled adverse events were not significantly higher with peppermint oil than placebo. The Summary likewise says adverse events appeared no more common with peppermint oil; it also reports heartburn and suggests relaxation of esophageal muscle as a possible explanation. (LLM, conf=0.93)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Although the drug improved stool frequency and consistency, it had no effect on global symptoms (RR 0.44; 95% CI 0. 14 to 1 42).”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used first line for IBS
What the sources say
- Partly supportedcites [160] sourceExperimental — accuracy not yet measured
The “9. Loperamide” section (page not available) reports no statistically significant improvement in overall IBS symptoms compared with placebo. It gives RR 0.42, not the claimed 0.44, and does not report improvement in stool frequency or consistency. A nonsignificant result also does not establish that loperamide had no effect. (LLM, conf=0.88)
plainn = 42- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Issues with following a low FODMAP diet, as opposed to traditional dietary advice, include the need for a specialist dietitian to implement it, followed by close monitoring to avoid nutritional deficiencies or the development of overly restrictive eating habits.[207][208][209]”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Fibre and dietary therapies
What the sources say
- Partly supportedcites [207] sourceExperimental — accuracy not yet measured
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
- Not checked — no full text of the sourcecites [208] Wilson, 2020, Challenges of the low FODMAP diet for managing irritable bowel syndrome and approaches to their minimisation and mitigation, Proc Nutr Soc source
- Not checked — no full text of the sourcecites [209] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“In contrast, in this meta-analysis, neither alverine nor mebeverine demonstrated benefit over placebo.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used first line for IBS
What the sources say
- Supportedcites [160] source
The Antispasmodics section states that mebeverine and alverine, each evaluated in one trial, did not have a statistically significant effect on IBS symptoms. It cautions that the numbers of patients studied were small. (LLM, conf=0.94)
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Although both stimulant and osmotic laxatives are efficacious in the treatment of chronic idiopathic constipation, 220 only the latter have been evaluated in 2 RCTs of polyethylene glycol, recruiting 181 patients with IBS-C.221 222”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used first line for IBS
What the sources say
- Supportedcites [220] source
Citation 220 is attached to the claim that both stimulant and osmotic laxatives are efficacious for chronic idiopathic constipation. The 'Efficacy and safety of laxatives in CIC' section reports better response than placebo for each, and the Discussion likewise states beneficial effects for both. The separate IBS-C trial claim is attached to citations 221 and 222, not this source. (LLM, conf=0.94)
- Not checked — no full text of the sourcecites [221] source
- Not checked — no full text of the sourcecites [222] source
plainn = 181- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Comparison of peppermint oil and antispasmodics with other unlicensed or 'traditional' treatments for IBS, including ispaghula and gutbrain neuromodulators, in a network meta-analysis suggested that, for global symptoms, peppermint oil was ranked first and antispasmodics third, with both superior to placebo (online supplemental figure 6).157”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used first line for IBS
What the sources say
- Supportedcites [157] source
The Global IBS Symptoms results (p. 18) rank peppermint oil first and antispasmodic drugs third in the Western-trials sensitivity analysis. The Discussion (p. 22) reports that both were significantly more efficacious than placebo for global symptoms, while noting no significant differences between active treatments. (LLM, conf=0.90)
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Preliminary data suggest that response to a low FODMAP diet may be predicted from baseline faecal bacterial profile and metabolomic activity, while a gluten-free diet may benefit those with serum antigliadin antibodies.[213][214][215]”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Fibre and dietary therapies
What the sources say
- Not checked — no full text of the sourcecites [213] source
- Supportedcites [214] source
The Discussion (page not provided) reports that baseline faecal volatile-organic-compound profiles predicted response to a low-FODMAP diet and describes earlier studies using bacterial profiles. This supports the preliminary claim about baseline bacterial and metabolomic predictors. The gluten-free-diet and antigliadin-antibody clause is not attributed to this paper specifically within the three-citation cluster. (LLM, conf=0.88)
- Not checked — no full text of the sourcecites [215] Pinto-Sanchez MI , Nardelli A , Borojevic R , et al . Gluten-Free Diet Reduces Symptoms, Particularly Diarrhea, in Patients With Irritable Bowel Syndrome and Antigliadin IgG. Clinical Gastroenterology and Hepatology 2020;150.doi:10.1016/j.cgh.2020.08.040 source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“We updated a prior meta-analysis of 37 RCTs, 158 incorporating data from 8 new trials [166][167][168][169][170][171][172][173] and randomising 6352 patients.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Probiotics
What the sources say
- Supportedcites [158] source
The Efficacy of Probiotics in the Treatment of IBS section (page unavailable) reports a meta-analysis of 37 probiotic-versus-placebo RCTs, supporting the description of the cited prior analysis. The eight new trials and 6,352 patients describe the citing authors’ update, not a result attributed to this source. (LLM, conf=0.91)
- Not checked — no full text of the sourcecites [166] Barraza-Ortiz, 2020, Combination of a probiotic and an antispasmodic increases quality of life and reduces symptoms in patients with irritable bowel syndrome: a pilot study, Dig Dis source
- Not checked — no full text of the sourcecites [167] source
plainn = 6,352- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“The overall rates of adverse events were significantly higher with antispasmodics compared with placebo; most notably dry mouth, visual disturbance and dizziness.160”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used first line for IBS
What the sources say
- Supportedcites [160] source
The Antispasmodics section reports that pooled adverse-event incidence was significantly higher with antispasmodics than with placebo (RR 1.60; 95% CI 1.15–2.21). It names dry mouth, dizziness, and blurred vision as the commonest adverse events; blurred vision matches the claim’s visual disturbance. (LLM, conf=0.94)
plaindirectn = 426- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“The prior systematic review and meta-analysis identified only 2RCTs, 161 comprising 111 participants and noted that although a gluten-free diet was associated with a reduction in global symptoms compared with a control diet, this was not statistically significant (RR 0.42; 95% CI 0. 11 to 1 55).”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Fibre and dietary therapies
What the sources say
- Supportedcites [161] source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaincorrelationaln = 111- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“In terms of effect on abdominal pain, antispasmodics ranked second, with peppermint oil third (online supplemental figure 7).Again, both were significantly more efficacious than placebo.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used first line for IBS
What the sources say
- Supportedcites [157] source
The ‘Failure to Achieve an Improvement in Abdominal Pain’ section (p. 19) states that antispasmodic drugs ranked second and peppermint oil third. It also reports that both were significantly more efficacious than placebo at 4–12 weeks. (LLM, conf=0.95)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Adverse events included constipation, nausea and headache, and adverse events leading to drop out were significantly higher with active drug than placebo.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used second line for the treatment of IBS-D
What the sources say
- Partly supportedcites [153] sourceExperimental — accuracy not yet measured
The Outcome assessment section (page unavailable) lists constipation, nausea and headache among the individual adverse events assessed. The Safety section (page unavailable) reports significantly more adverse-event-related dropouts than placebo for both studied doses of eluxadoline and for alosetron 1 mg twice daily, but not for active drugs generally. (LLM, conf=0.88)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Pregabalin improved visceral hypersensitivity in one small trial, 227 and in a recent RCT recruiting 85 patients with IBS, 12 weeks of pregabalin 225 mg twice daily led to significant improvements in global symptoms, abdominal pain, diarrhoea and bloating versus placebo.228”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Gut-brain neuromodulators
What the sources say
plaindirectn = 85- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In contrast, SSRIs were ranked fifth and fourth for global symptoms and abdominal pain, respectively, and pregabalin was ranked sixth for global symptoms, with no benefit of either over placebo in these trials.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Gut-brain neuromodulators
What the sources say
- Partly supportedcites [157] sourceExperimental — accuracy not yet measured
The Results on global IBS symptoms (p. 18) and abdominal pain (p. 19) identify only peppermint oil, TCAs, and antispasmodic drugs as significantly more effective than placebo, supporting the statement that SSRIs and pregabalin showed no demonstrated benefit on the relevant endpoints. The passages in our copy do not give the claimed fifth, fourth, and sixth rankings, so those precise ranks remain unsupported. (LLM, conf=0.80)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In a previous metaanalysis, 153 both alosetron 1 mg two times per day and ramosetron 2.5 μg or 5 μg once a day were superior to placebo across various end points, including the FDA composite end point for IBS-D (3 RCTs of alosetron 1 mg two times per day, 787 patients, RR 0.69; 95% CI 0.60 to 0.80, and 1 RCT of ramosetron 2.5 μg once a day, 348 patients, RR 0.78; 95% CI 0.67 to 0.91) (online supp”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used second line for the treatment of IBS-D
What the sources say
- Partly supportedcites [153] sourceExperimental — accuracy not yet measured
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaindirectn = 787- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“In a metaanalysis of 12 RCTs of TCAs, recruiting 787 patients, these drugs were superior to placebo for global symptoms or abdominal pain (RR 0.65; 95% CI 0.55 to 0.77) (online supplemental figure 8), and for abdominal pain alone (RR 0.59; 95% CI 0.42 to 0.83) (online supplemental figure 9).159”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Gut-brain neuromodulators
What the sources say
- Supportedcites [159] source
The Outcome Assessment and Box 2 sections define the main outcome as improvement in global IBS symptoms or, when unavailable, abdominal pain. The Efficacy of Antidepressants in the Treatment of IBS section reports 12 TCA RCTs with 787 patients, an RR of 0.65 (95% CI 0.55 to 0.77) for symptoms not improving, and an abdominal-pain RR of 0.59 (95% CI 0.42 to 0.83). (LLM, conf=0.95)
plaindirectn = 787- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Both drugs were also more efficacious than placebo for global symptoms, abdominal pain and stool consistency (online supplemental figures 11-13).”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used second line for the treatment of IBS-D
What the sources say
- Supportedcites [153] source
The Results sections report that all treatments except rifaximin were significantly more effective than placebo for global IBS symptoms, and all treatments were significantly more effective for stool consistency. The abdominal-pain Results explicitly identify both alosetron and ramosetron as significantly more effective than placebo. Page numbers are not available in our copy. (LLM, conf=0.93)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“SSRIs were also more efficacious for global symptoms or abdominal pain (RR 0.68; 95% CI 0.51 to 0.91) (online supplemental figure 8), but not abdominal pain alone (online supplemental figure 9), and there was significant heterogeneity among the 7 trials, which contained only 356 patients.159”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Gut-brain neuromodulators
What the sources say
- Supportedcites [159] source
The Efficacy of Antidepressants in the Treatment of IBS section reports seven SSRI trials with 356 patients, an RR of symptoms not improving of 0.68 (95% CI 0.51–0.91), and statistically significant heterogeneity. The same section reports no statistically significant SSRI effect on abdominal pain alone. The Data Synthesis and Statistical Analysis section defines the pooled outcome as global IBS symptoms or abdominal pain not improving. (LLM, conf=0.94)
plaindirectn = 356- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“A network meta-analysis comparing the relative efficacy of all these licensed therapies for IBS-D, across various end points, 153 demonstrated that alosetron 1 mg two times per day ranked first for the FDA composite end point for IBS-D and global symptoms (online supplemental figures 10 and 11), with ramosetron 2.5 μg once a day second.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used second line for the treatment of IBS-D
What the sources say
- Partly supportedcites [153] sourceExperimental — accuracy not yet measured
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Eluxadoline is a μ-opioid and κ-opioid receptor agonist and δ-opioid receptor antagonist licensed for IBS-D. The drug slows intestinal transit and reduces visceral hypersensitivity. 229”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used second line for the treatment of IBS-D
What the sources say
- Partly supportedcites [229] sourceExperimental — accuracy not yet measured
The Background (Mechanism of action; page unavailable) confirms eluxadoline’s receptor profile and approval for IBS-D. The Background (Development; page unavailable) reports normalized GI transit in mice, consistent with slowing transit toward baseline. The paper discusses a rationale for effects on visceral sensation, but does not establish that eluxadoline reduces visceral hypersensitivity. (LLM, conf=0.86)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“In a network meta-analysis evaluating relative efficacy of gutbrain modulators with other unlicensed or 'traditional' treatments, 157 TCAs were ranked second and first for their effect on global symptoms and abdominal pain respectively, and were more efficacious than placebo (online supplemental figures 6 and 7).”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Gut-brain neuromodulators
What the sources say
- Supportedcites [157] source
The Results report that TCAs ranked second for improvement in global IBS symptoms (p. 18) and first for improvement in abdominal pain (p. 19). Both sections report significantly greater efficacy than placebo in the main analysis. The Discussion (p. 22) notes that the abdominal-pain ranking changed in an analysis restricted to Western trials. (LLM, conf=0.94)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Finally, for stool consistency alosetron 1 mg two times per day ranked first, with ramosetron 5 μg once a day second (online supplemental figure 12).”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used second line for the treatment of IBS-D
What the sources say
- Supportedcites [153] source
The Results section (‘Failure to achieve a stool consistency response’; page not provided) ranks alosetron 1 mg twice daily first. The Discussion (page not provided) explicitly ranks ramosetron 5 µg once daily second for its effect on stool consistency. (LLM, conf=0.94)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Ramosetron is only available in Asia. 153 There have been no reports of ischaemic colitis associated with the drug.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used second line for the treatment of IBS-D
What the sources say
- Supportedcites [153] source
The citation is attached to the availability sentence. The Discussion states that ramosetron is licensed only in Japan and some other South and Southeast Asian countries, supporting the claim that it is available only in Asia. The separate sentence about ischaemic colitis is not attached to this citation. (LLM, conf=0.88)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Adverse events included constipation, nausea and headache; patients assigned to both drugs were more likely to report adverse events than with placebo.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used second line for the treatment of IBS-D
What the sources say
- Partly supportedcites [153] sourceExperimental — accuracy not yet measured
The Safety section (page unavailable) reports significantly more overall adverse events with alosetron 1 mg twice daily and ramosetron 2.5 µg once daily than with placebo. The Discussion identifies constipation as an adverse event, but our copy does not identify nausea or headache among the reported events. (LLM, conf=0.86)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Adverse events were signifi- cantly more common with linaclotide 290 μg once a day, with diarrhoea being the most common.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used second line for the treatment of IBS-C
What the sources say
- Partly supportedcites [155] sourceExperimental — accuracy not yet measured
The Safety section (p. 19) reports significantly more overall adverse events with linaclotide 290 μg once daily than with placebo (RR 1.12; 95% CI 1.04–1.21). The adverse-event discussion (p. 20) reports an increased risk of diarrhea with linaclotide, but does not establish that diarrhea was its most common adverse event. (LLM, conf=0.85)
plaindirectn = 3,193- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Adverse event rates were significantly higher among patients treated with TCAs or SSRIs, with drowsiness and dry mouth the most common.159”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Gut-brain neuromodulators
What the sources say
- Partly supportedcites [159] sourceExperimental — accuracy not yet measured
The “Adverse Events with Antidepressant Therapy” section reports significantly more adverse events with antidepressants overall and with TCAs specifically. It says drowsiness and dry mouth were more common with TCAs than placebo, but does not establish a significantly higher adverse-event rate for SSRIs separately or identify those effects as the most common across both drug classes. (LLM, conf=0.88)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In a meta-analysis of 2 RCTs, 153 which recruited 1260 patients, rifaximin 550 mg three times a day for 14 days was more efficacious than placebo for the FDA composite end point for IBS-D (RR 0.92; 95% CI 0.86 to 0.98) (online supplemental figure 10) and for stool consistency alone (online supplemental figure 12), but not for global symptoms or abdominal pain (online supple- mental figures 11 and”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used second line for the treatment of IBS-D
What the sources say
- Partly supportedcites [153] sourceExperimental — accuracy not yet measured
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaindirectn = 1,260- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Drugs acting as antagonists at the 5-HT 3 receptor are also licensed for IBS-D. These include alosetron and ramosetron, which slow gastrointestinal transit, reduce visceral hypersensitivity and alter rectal compliance. [231][232][233]”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used second line for the treatment of IBS-D
What the sources say
- Partly supportedcites [231] sourceExperimental — accuracy not yet measured
The Summary reports that alosetron delayed colonic transit in IBS patients and healthy volunteers. It also describes reduced rectal sensitivity with granisetron, increased rectal compliance with ondansetron, and increased colonic—not rectal—compliance with alosetron. The paper does not establish that alosetron or ramosetron was licensed for IBS-D, or report these effects for ramosetron; the Discussion instead calls alosetron a suitable treatment candidate. (LLM, conf=0.88)
- Not checked — no full text of the sourcecites [232] source
- Not checked — no full text of the sourcecites [233] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Headache was the most common adverse event, but side effects were no more common with rifaximin than with placebo.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used second line for the treatment of IBS-D
What the sources say
- Partly supportedcites [153] sourceExperimental — accuracy not yet measured
The Safety section (page unavailable) reports that rifaximin ranked best for overall adverse events and does not identify a significant increase versus placebo. The Outcome assessment section lists headache among the adverse events assessed, but our copy does not say it was the most common. (LLM, conf=0.84)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“in the largest trial of CBT for IBS conducted to date at least 50% of patients met cutoffs for probable common mental disorders at baseline, and both therapist-delivered CBT over the telephone and web-based CBT using IBS-specific protocols reduced anxiety and depression scores at all follow-up points.86”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Psychological therapies
What the sources say
- Partly supportedcites [86] sourceExperimental — accuracy not yet measured
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Although prucalopride, which is a highly selective 5-HT 4 agonist with no known cardiovascular or cerebrovascular safety concerns, is efficacious in the treatment of chronic idiopathic constipation, 220 to date there have been no RCTs in IBS-C.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used second line for the treatment of IBS-C
What the sources say
- Partly supportedcites [220] sourceExperimental — accuracy not yet measured
The Response to therapy with prucalopride section reports better outcomes than placebo in chronic idiopathic constipation, supporting efficacy. The paper reviews trials in that condition but does not establish the separate claim that no prucalopride RCTs had been conducted in IBS-C; a search for IBS-C trials found no passage addressing it. Page numbers were not available in our copy. (LLM, conf=0.86)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Analysis of trials that only included patients with refractory symptoms reduced the heterogeneity, and still demonstrated efficacy for CBT in some formats (online supple- mental figure 21).”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Psychological therapies
What the sources say
- Supportedcites [156] source
The Results section reports very little heterogeneity when analysis was restricted to 13 trials recruiting only patients with refractory IBS; the Discussion describes moderate heterogeneity in the main analysis. The Abstract reports efficacy for group CBT, telephone CBT, and internet CBT against specified controls in the refractory-symptom trials. (LLM, conf=0.92)
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“a meta-analysis of 6 RCTs, recruiting 639 patients, reported a RR of remaining symptomatic of 0.73 (95% CI 0.55 to 0.97) compared with education and/or support and 0.67 (95% CI 0.49 to 0.91) compared with a waiting list control (online supplemental figure 20).156”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Psychological therapies
What the sources say
- Partly supportedcites [156] sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaindirectn = 639- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Adverse events were significantly more frequent with plecanatide 3 μg once a day, compared with placebo, and diarrhoea was significantly more likely with both doses.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used second line for the treatment of IBS-C
What the sources say
- Partly supportedcites [155] sourceExperimental — accuracy not yet measured
The Safety section (p. 19) reports significantly more overall adverse events with plecanatide 3 mg once daily than with placebo. It also reports that both plecanatide doses were significantly more likely to cause diarrhea than placebo (p. 20). The claim gives the 3 mg dose as 3 μg, a 1,000-fold difference. (LLM, conf=0.90)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“and an increase of ≥1 CSBMs per week from baseline (online supplemental figure 16).”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used second line for the treatment of IBS-C
What the sources say
- Supportedcites [155] source
The Data Extraction section (p. 12) defines CSBM response as an increase of at least one CSBM per week from baseline for at least 50% of weeks. The results (p. 18) report that tenapanor 50 mg twice daily was significantly more effective than placebo for CSBM response. (LLM, conf=0.92)
plaindirect- Asserted: fails — The authors may not put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The authors may not put it forward as true. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Early reports of clinical outcomes via videoconsultation are also promising, with similar response rates achieved, compared with face-to-face treatment.259”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Psychological therapies
What the sources say
- Supportedcites [259] source
The Results section reports a 65% response rate for Skype hypnotherapy versus 76% for face-to-face treatment, with no statistically significant difference after age adjustment. The Discussion calls the results encouraging while noting that Skype treatment might be marginally less effective. The comparison concerns hypnotherapy for irritable bowel syndrome. (LLM, conf=0.88)
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“However, intervention with gut-focused hypnotherapy has been shown to have wider socioeconomic benefits including improving general well-being, reductions in healthcare utilisation in both primary and secondary care, [254][255][256] reduced presenteeism at work, 255 improved quality of life 252 257 and long-term beneficial effects on symptoms, 256”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Psychological therapies
What the sources say
- Not checked — no full text of the sourcecites [254] source
- Not checked — no full text of the sourcecites [255] Houghton, 1996, Symptomatology, quality of life and economic features of irritable bowel syndrome--the effect of hypnotherapy, Aliment Pharmacol Ther source
- Supportedcites [256] source
Citation 256 is attached to reduced healthcare use and long-term symptom benefits, not to the separate presenteeism claim. The Consultation rates section reports that patients saw their GP and hospital consultant less often after hypnotherapy; the Abstract and Discussion report sustained symptom improvement for at least five years. The paper also reports improvements in well-being and quality of life. (LLM, conf=0.93)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“IBS research is leading the way in this regard with the first UK interventional virtual trial being conducted in IBS, demonstrating that virtual recruitment methods outperform site-dependent recruitment significantly.295 299”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > RESEARCH: BARRIERS, PRIORITIES AND IMPLICATIONS FOR FUTURE STUDY DESIGN
What the sources say
- Partly supportedcites [295] Kemppinen, 2020, Randomised, double-blind, placebo controlled multi-centre study to assess the efficacy, tolerability and safety of Enterosgel® in the treatment of irritable bowel syndrome with diarrhoea (IBS-D) in adults, Trials sourceExperimental — accuracy not yet measured
The Methods/design > Recruitment section describes an IBS-D interventional trial in England that uses a website and registry alongside recruitment through approximately 30 clinical sites (page not specified). It does not identify the study as the first UK interventional virtual trial or report a comparison showing that virtual recruitment significantly outperformed site-dependent recruitment. (LLM, conf=0.87)
- Not matchedcites [299] Virtual trial recruits 67% faster led by NIHR Patient Recruitment Centre in Newcastle in collaboration with Enteromed, 2020. Available: https://www.nihr.ac.uk/news/virtual-trial-recruits-67-faster-led-by-nihr-patient-recruitment-centre-in-newcastle-in-collaboration-with-enteromed/26290
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The drug was welltolerated, with diarrhoea the most common side effect, and there were no cardiovascular adverse events.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs in development
What the sources say
- Not checked — no full text of the sourcecites [179] source
- Partly supportedcites [180] sourceExperimental — accuracy not yet measured
The Discussion says minesapride was well tolerated, and the Results > Safety identifies diarrhoea as the most common treatment-emergent adverse event. But the Results > Safety also reports tachycardia in a patient taking 40 mg, leading to discontinuation, so the statement that there were no cardiovascular adverse events is not supported. (LLM, conf=0.92)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
Every source the paper cites for this claim was checked and supports it.
In the paper
“Among individuals who believe themselves to have IBS, only around 60% fulfil Rome IV criteria, whereas 80% fulfil Rome III.23”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > RESEARCH: BARRIERS, PRIORITIES AND IMPLICATIONS FOR FUTURE STUDY DESIGN
What the sources say
- Supportedcites [23] source
The Results section ('Proportion of Individuals with IBS Meeting the Rome III and Rome IV Criteria and Level of Agreement') reports that 59.1% of self-identified IBS respondents with complete Rome IV data met those criteria, while 78.9% with complete Rome III data met Rome III criteria. The Discussion likewise summarizes these figures as 60% and almost 80% among people who believe they have IBS. (LLM, conf=0.95)
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Furthermore, patients are at increased risk of iatrogenic harms, through unnecessary surgery, including hysterectomy, appendicectomy and cholecystectomy, 121 and inappropriate prescribing of opioids.90”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Guidelines
What the sources say
- Supportedcites [121] source
Citation 121 is attached to the surgery claim, not the separate opioid-prescribing claim cited to 90. The Discussion reports increased rates of cholecystectomy, appendectomy and hysterectomy in patients with IBS and explicitly describes a risk of unnecessary surgery for all three (page not supplied). (LLM, conf=0.93)
- Supportedcites [90] Black, 2020, Functional gastrointestinal disorders: advances in understanding and management, The Lancet source
The citation to this source is attached to the surgery clause, not the separate opioid-prescribing clause. In Natural History and Effect, the paper reports higher rates of cholecystectomy, appendicectomy, and hysterectomy among people with IBS than among those without IBS; it also describes unnecessary surgery for FGID symptoms. (LLM, conf=0.91)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Current treatments for IBS are often inadequate and many patients remain unsatisfied with medical care.91 92 95”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > RESEARCH: BARRIERS, PRIORITIES AND IMPLICATIONS FOR FUTURE STUDY DESIGN
What the sources say
- Not checked — no full text of the sourcecites [91] source
- Not checked — no full text of the sourcecites [92] Bertram, 2001, The patient’s perspective of irritable bowel syndrome, J Fam Pract
- Supportedcites [95] source
The Introduction says effective treatment options for IBS are lacking. In “Impact on health service use,” most participants reported alienation from health services, including poor relationships with doctors and a belief that the NHS could offer no help for IBS. These passages support both parts of the claim. (LLM, conf=0.91)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“An RCT of delayed-release linaclotide, with action confined to the ileo-caecal region of the gastrointestinal tract, demonstrated significant effects on abdominal pain, with lower rates of diarrhoea than conventionrelease linaclotide.165”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs in development
What the sources say
- Partly supportedcites [165] sourceExperimental — accuracy not yet measured
The Introduction (page unavailable) says MD-7246 was designed to release at the ileocecal junction and cecum, but does not establish that its action was confined there. The Results (page unavailable) report modest abdominal-pain improvement with MD-7246, without a statistically significant effect versus placebo; the significant pain result was for DR1, which targets the ileum. The Safety results report lower diarrhea rates with MD-7246 than with immediate-release linaclotide. (LLM, conf=0.88)
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Peppermint oil may be an effective treatment for global symptoms and abdominal pain in IBS.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > First-line treatments
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Loperamide may be an effective treatment for diarrhoea in IBS.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > First-line treatments
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Soluble fibre, such as ispaghula, is an effective treatment for global symptoms and abdominal pain in IBS, but insoluble fibre (eg, wheat bran) should be avoided as it may exacerbate symptoms.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > First-line treatments
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The non-absorbable antibiotic rifaximin is an efficacious second-line drug for IBS with diarrhoea in secondary care, although its effect on abdominal pain is limited.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Second-line treatments
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“However, studies do not distinguish between affective, cognitive and true peripheral, versus central, mechanisms of visceral hypersensitivity.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Altered visceral perception
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Tegaserod, a 5-Hydroxytryptamine 4 receptor agonist, is an efficacious second-line drug for IBS with constipation in secondary care but is unavailable outside the USA.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Second-line treatments
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Interestingly, those studies that compared the low FODMAP diet with traditional dietary advice from NICE and the BDA had the least heterogeneity, but also the least magnitude of effect (RR 0.82; 95% CI 0.67 to 1.01), suggesting that the 50%-70% symptomatic benefit reported for a low FODMAP diet in some studies may have been overestimated.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Fibre and dietary therapies
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“In one trial, there was no significant effect on either abdominal pain or number of bowel movements, 221 and in the second the number of bowel movements increased significantly, but with no improvement in abdominal pain.222”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used first line for IBS
What the sources say
plainn = 181- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Polyethylene glycol was generally well-tolerated with abdominal pain the most frequent adverse event.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used first line for IBS
What the sources say
plainn = 181- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Blurred vision, dizziness and altered sensation were more common with pregabalin.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Gut-brain neuromodulators
What the sources say
- Not checked — no full text of the sourcecites [228] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“In this RCT, patients received open-label rifaximin and were then randomised to two repeat 14-day courses of rifaximin or placebo if they experienced symptom relapse.Significantly more patients experienced an improvement in global symptoms with rifaximin after each treatment course, and there were no safety concerns.238”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used second line for the treatment of IBS-D
What the sources say
- Not checked — no full text of the sourcecites [238] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“A subsequent RCT of 12 mg once a day of bimodal release ondansetron also demonstrated superiority over placebo for improvement in stool consistency, but not abdominal pain.178”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used second line for the treatment of IBS-D
What the sources say
- Not checked — no full text of the sourcecites [178] source
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Each section lead performed a comprehensive literature search, except for the section dealing with treatment, which was informed by a systematic review of the literature, the methodology for which is reported within that section.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Methodology
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“In the absence of any biomarker being available for IBS, the condition is diagnosed using a positive approach, based on the clinical history.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > CLASSIFICATION AND DIAGNOSTIC CRITERIA
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The autonomic nervous system mediates communication between the gut and brain.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Central nervous system and autonomic nervous system modulation
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
In the paper
“In the latter instance, IBS is chronic, with fluctuating symptoms, in the majority of patients.12”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > EPIDEMIOLOGY
What the sources say
- Not checked — no full text of the sourcecites [12] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“In IBS, a reduction in parasympathetic activity and an increase in sympathetic nervous system activity is frequently observed.39”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Central nervous system and autonomic nervous system modulation
What the sources say
- Not checked — no full text of the sourcecites [39] source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Conversely, the vagus nerve may sense the gut microenvironment indirectly and transfer this information to the brain.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Central nervous system and autonomic nervous system modulation
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Moving from Rome III to Rome IV IBS may therefore reduce the likelihood of novel pharmacological therapies demonstrating efficacy in future randomised controlled trials (RCTs), due to the spectrum of symptom severity, or may mean that trials need to be considerably larger, and therefore more expensive to conduct, to show a beneficial effect.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Guidelines
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The pathophysiology of IBS is complex and remains poorly understood. 2”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > PATHOPHYSIOLOGY
What the sources say
- Not checked — no full text of the sourcecites [2] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“In both meta-analyses, heterogeneity between studies was substantial, presumably relating to differences in methodology, demographic characteristics of participants, cultural issues or a combination of these factors.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > EPIDEMIOLOGY
What the sources say
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The presence of abdominal pain at the required frequency distinguishes IBS from the other functional bowel disorders, which consist of functional constipation, functional diarrhoea and functional abdominal bloating or distension. 2”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > CLASSIFICATION AND DIAGNOSTIC CRITERIA
What the sources say
- Not checked — no full text of the sourcecites [2] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This more restrictive nature of the Rome IV criteria calls into question whether they should be used to diagnose IBS in clinical practice, and a more pragmatic definition of the symptoms that constitute IBS may be preferred.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > CLASSIFICATION AND DIAGNOSTIC CRITERIA
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
In the paper
“Colonic transit is abnormal in only 10%-20% of patients with IBS-C and IBS-M, and 25%-45% of patients with IBS-D.44 45”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Transit and motility
What the sources say
- Not matchedcites 44 45
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
In the paper
“Establishing an effective doctor-patient relationship and a shared understanding is key to the successful diagnosis and management of chronic conditions such as IBS.89 90”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Doctor-patient communication and patient perspectives in primary care
What the sources say
- Not matchedcites 89 90
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Not matched
In the paper
“The expression and levels of the tight junction protein zonula occludens are significantly reduced in IBS-D, and associated with mast cell activation and symptoms.66”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Immune regulation, inflammation and epithelial permeability
What the sources say
- Not checked — no full text of the sourcecites [66] source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Their applicability to clinical practice has been challenged as unnecessarily restrictive, 98 and only a minority of people diagnosed with IBS in primary care fulfil them.99”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Diagnosis of IBS in primary care
What the sources say
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim could be matched to a paper in Crossref, so there is nothing to check it against.
In the paper
“Increased permeability in patients with PI-IBS and IBS-D correlates with visceral sensitivity 60 61 and symptom severity.62 63”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Immune regulation, inflammation and epithelial permeability
What the sources say
- Not matchedcites 60 61
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites 62 63
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
In the paper
“Moreover, changes in the gut microbiome can modify gastrointestinal motility, visceral sensation, intestinal permeability, stool consistency and visceral sensitivity.71 72”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > The microbiome
What the sources say
- Not matchedcites 71 72
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
In the paper
“The non-invasive marker of intestinal inflammation faecal calprotectin has enabled risk stratification to prioritise access to investigations to exclude IBD in patients with chronic diarrhoea, reducing unnecessary investigations and referrals from primary to secondary care.103”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Investigation in primary care
What the sources say
- Not matchedcites [103] The new faecal calprotectin care pathway, 2018. Available: https://wwwniceorguk/sharedlearning/the-new-faecal-calprotectin-care-pathway
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
In the paper
“the gold standard symptombased diagnostic criteria for IBS, the Rome criteria, are now in their fourth iteration.2”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > INTRODUCTION Aims
What the sources say
- Not checked — no full text of the sourcecites [2] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“The Rome diagnostic criteria are based on specific symptoms of a defined duration and frequency, 2 which have been derived predominantly from secondary care patients, and are rarely used in primary care.97”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Diagnosis of IBS in primary care
What the sources say
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Patients with IBS-C display reduced motility, fewer high amplitude propagating contractions of the colon and delayed transit, whereas those with IBS-D have increased motility, more high amplitude propagating contractions and accelerated transit. 1”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Transit and motility
What the sources say
- Not checked — no full text of the sourcecites [1] source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“They often feel their symptoms are dismissed or trivialised, describe the diagnostic process as confusing, or invasive, and the often-lengthy search for efficacious treatments as frustrating.87 89 91 -95”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Doctor-patient communication and patient perspectives in primary care
What the sources say
- Not matchedcites 87 89 91 -95
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
In the paper
“Hence, most patients with IBS are keen to explore dietary options, with over 60% wanting to know what food(s) they should avoid, and up to 70% having modified their diet.192”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Fibre and dietary therapies
What the sources say
- Not checked — no full text of the sourcecites [192] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Coexistent early satiety, postprandial fullness, epigastric pain, nausea or heartburn are common, as functional dyspepsia and gastro-oesophageal reflux frequently overlap with IBS.[115][116][117]”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > CLINICAL HISTORY AND INVESTIGATION IN SECONDARY CARE The first consultation in secondary care
What the sources say
- Not matchedcites [115][116][117]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
In the paper
“Extraintestinal symptoms, such as back pain, bladder and gynaecological symptoms, and insomnia are frequent, as is the presence of other functional somatic disorders, such as fibromyalgia, tension headache or chronic fatigue.118”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > CLINICAL HISTORY AND INVESTIGATION IN SECONDARY CARE The first consultation in secondary care
What the sources say
- Not checked — no full text of the sourcecites [118] Petersen, 2020, The unifying diagnostic construct of bodily distress syndrome (BDS) was confirmed in the general population, J Psychosom Res source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“IBS is not associated with an increased risk of cancer or mortality, 149 but affects quality of life to the same degree as organic gastrointestinal diseases, such as IBD. 13”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Communicating a positive diagnosis and management plan in secondary care
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Local laboratory values vary but, generally, a faecal calprotectin of <100 μg/g can be considered normal, 100-249 μg/g is borderline and should be repeated, with subsequent referral if persistently elevated, and ≥250 μg/g requires urgent referral to secondary care to exclude IBD.103”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Investigation in primary care
What the sources say
- Not matchedcites [103] The new faecal calprotectin care pathway, 2018. Available: https://wwwniceorguk/sharedlearning/the-new-faecal-calprotectin-care-pathway
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
- Not matched
In the paper
“Factors that should alert the clinician to the possibility of microscopic colitis include female sex, age ≥50 years, coexistent autoimmune disease, nocturnal or severe, watery, diarrhoea, duration of diarrhoea <12 months, weight loss or use of potential precipitating drugs including NSAIDs, PPIs, selective serotonin reuptake inhibitors (SSRIs) or statins.[127][128][129]”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Investigations in secondary care
What the sources say
- Not matchedcites [127][128][129]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In addition, most trials recruited unselected patients with IBS, so whether the proposed reduc- tion in gastrointestinal motility with antispasmodics improves diarrhoea is unclear.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used first line for IBS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“However, these findings should be interpreted with caution, given heterogeneity between trial results and the varying end points studied.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used first line for IBS
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In addition, low study quality, the lack of consistent use of the Rome criteria to define IBS and heterogeneity between RCTs limit confidence in the data.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used first line for IBS
plaincorrelationaln = 823- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Although not completely understood, its putative antispasmodic action is via L-menthol's blockade of calcium channels.218”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used first line for IBS
What the sources say
- Not checked — no full text of the sourcecites [218] source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Current NICE guidance for the management of IBS suggests that patients with IBS-C can be treated with laxatives, advising dose titration according to symptoms.10”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used first line for IBS
What the sources say
- Not checked — no full text of the sourcecites [10] source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Loperamide is a synthetic μ-opioid agonist that reduces myenteric plexus activity, thereby increasing intestinal transit time and enhancing water reabsorption.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used first line for IBS
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The long-term efficacy of osmotic laxatives in IBS-C is unknown, as both trials were of only 4 weeks duration.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used first line for IBS
plainn = 181- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Probiotics, as a group, may be an effective treatment for global symptoms and abdominal pain in IBS, but it is not possible to recommend a specific species or strain.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Recommendations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Due to the modest efficacy, and concerns over the potential for adverse events (including Clostridium difficile infection and bacterial resistance) with repeated courses of rifaximin, FDA approval was not forthcoming.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used second line for the treatment of IBS-D
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Patients with IBS often have comorbid anxiety and depression, 119 and these are also risk factors for the subsequent development of IBS in healthy people.31”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Gut-brain neuromodulators
What the sources say
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“There have been no RCTs of SNRIs in IBS, although there is evidence from case series that duloxetine may improve symptoms and quality of life, 224 225 and there is good evidence for use of SNRIs in other chronic painful disorders, such as fibromyalgia and low back pain.226”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Gut-brain neuromodulators
What the sources say
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Although licensed for IBS-D, the drug is unavailable in many countries.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used second line for the treatment of IBS-D
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The drug is now licensed for IBS-D in the USA but is not available for this indication in many countries.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used second line for the treatment of IBS-D
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It is likely that these approaches have similar efficacy, but more work is needed to determine cost-effectiveness of the various modes of delivery.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Psychological therapies
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“In one European study, approximately one in four individuals with IBS were categorised as severe in a general population setting.266”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Approach to the patient with severe or refractory symptoms
What the sources say
- Not checked — no full text of the sourcecites [266] Manzoli, 2017, Prevalence of severe irritable bowel syndrome among Italian adults, A meta-analysis. Eur Rev Med Pharmacol Sci source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Diarrhoea was the most common adverse event and was significantly more likely than with placebo.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs used second line for the treatment of IBS-C
What the sources say
- Not checked — no full text of the sourcecites [163] source
plaindirectn = 9,242- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Although the risk of missing, or subsequently developing, an organic disorder in patients diagnosed with IBS is low, this rate may be increased in those with severe symptoms, 267”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Approach to the patient with severe or refractory symptoms
What the sources say
- Not checked — no full text of the sourcecites [267] source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These data suggest that treatment with IBS-specific CBT protocols may benefit both mental health and gastrointestinal symptoms.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Psychological therapies
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“There were also significant improvements in extraintestinal symptoms, and anxiety and depression scores.252”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Psychological therapies
What the sources say
- Not checked — no full text of the sourcecites [252] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Evidence suggests, therefore, that CBT for IBS is effective in both high-intensity (therapist-delivered) and minimal contact (therapist-guided) formats, as well as self-administered with either bibliographic material or web-based.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Psychological therapies
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The cannabinoid type-2 receptor agonist, olorinab, has been tested in patients with quiescent Crohn's disease, and led to reductions in abdominal pain and improved bowel movements 293”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Drugs in development
What the sources say
- Not checked — no full text of the sourcecites [293] Yacyshyn, 2019, Su1930 – Safety and Efficacy of Olorinab, a Peripherally Restricted, Highly Selective, Cannabinoid Receptor 2 Agonist in a Phase 2A Study in Chronic Abdominal Pain Associated with Crohn’s Disease, Gastroenterology source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This would allow faster recruitment to RCTs, provide equity of access for patients and give a better indication of the true benefit of treatments being studied in the population most likely to use them.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > RESEARCH: BARRIERS, PRIORITIES AND IMPLICATIONS FOR FUTURE STUDY DESIGN
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.
- Rests on an assumption: There are often severity criteria built in, which aim to exclude the most severe or refractory symptoms, as well as less severe cases.
- Rests on an assumption: Many treatments are restricted to patients with IBS-C or IBS-D, whereas those with IBS-M or IBS-U are rarely recruited.
- Rests on an assumption: Although there are established composite end points for IBS-C and IBS-D, these do not exist for IBS-M or IBS-U.
- Rests on an assumption: Recruitment to trials is optimal when patients are linked to specialist clinics.
- Rests on an assumption: Patients with IBS are widely disseminated, mostly in community care, often with no long-term follow-up, and only a minority attend specialist clinics where research is undertaken.
- Rests on an assumption: The latter group (specialist clinic patients) is often more complex, more refractory and, by definition, less appropriate for treatment trials.
- Rests on an assumption: There are often too many visits, a need for invasive investigations, and a high burden of data collection.
- Rests on an assumption: Patients who enter IBS trials have usually tried all available treatments and remain unsatisfied with care, so being randomised to 'standard care' for ≥12 weeks is unappealing.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Nevertheless, it is important to stress that in most patients a diagnosis of IBS is secure, 111 and further repeated investigations have a low yield.268”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Approach to the patient with severe or refractory symptoms
What the sources say
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although RCTs remain the gold standard, they have many weaknesses, and modern methods of trial design may be more suitable to studying IBS.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > RESEARCH: BARRIERS, PRIORITIES AND IMPLICATIONS FOR FUTURE STUDY DESIGN
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
- Rests on an assumption: There are often severity criteria built in, which aim to exclude the most severe or refractory symptoms, as well as less severe cases.
- Rests on an assumption: Many treatments are restricted to patients with IBS-C or IBS-D, whereas those with IBS-M or IBS-U are rarely recruited.
- Rests on an assumption: Although there are established composite end points for IBS-C and IBS-D, these do not exist for IBS-M or IBS-U.
- Rests on an assumption: Recruitment to trials is optimal when patients are linked to specialist clinics.
- Rests on an assumption: Patients with IBS are widely disseminated, mostly in community care, often with no long-term follow-up, and only a minority attend specialist clinics where research is undertaken.
- Rests on an assumption: The latter group (specialist clinic patients) is often more complex, more refractory and, by definition, less appropriate for treatment trials.
- Rests on an assumption: There are often too many visits, a need for invasive investigations, and a high burden of data collection.
- Rests on an assumption: Patients who enter IBS trials have usually tried all available treatments and remain unsatisfied with care, so being randomised to 'standard care' for ≥12 weeks is unappealing.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Despite this, and the high prevalence of IBS, the pipeline of new treatments is relatively poor.”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > RESEARCH: BARRIERS, PRIORITIES AND IMPLICATIONS FOR FUTURE STUDY DESIGN
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“is a multifactorial disorder of gut-brain interaction”
§ British Society of Gastroenterology guidelines on the management of irritable bowel syndrome > Additional information
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
The paper relies on this without support.
The evidence from clinical trials and meta-analyses is applicable to the general IBS population in clinical practice.
“The primary aim of this guideline, commissioned by the BSG, is to review and summarise the current evidence to inform and guide clinical practice, by providing a practical framework for evidence-based management of patients.”
The paper relies on this without support.
The recommendations will lead to improved patient outcomes.
“providing a practical framework for evidence-based management of patients.”
The paper relies on this without support.
The quality of evidence grading accurately reflects the certainty of the evidence.
“Specific recommendations have been made according to the Grading of Recommendations Assessment, Development and Evaluation system, summarising both the strength of the recommendations and the overall quality of evidence.”
The paper relies on this without support.
The main pathophysiological aspect of IBS is related to visceral hypersensitivity, which is also the principal target of many current treatments.
“The main pathophysiological aspect is related to visceral hypersensitivity, which is also the principal target of many current treatments.”
The paper relies on this without support.
IBS is a disorder of gut-brain interaction.
“explaining IBS as a disorder of gut-brain interaction”
The paper relies on this without support.
Cure is unlikely, but substantial improvement in symptoms, social functioning and quality of life is achievable.
“It is important to stress that cure is unlikely, but substantial improvement in symptoms, social functioning and quality of life is achievable.”
The paper relies on this without support.
Most second-line drugs are only available in secondary care.
“Most second-line drugs are only available in secondary care.”
The paper relies on this without support.
The treatment of IBS is generally directed towards the predominant symptom, or symptoms, experienced by the patient.
“The treatment of IBS is generally directed towards the predominant symptom, or symptoms, experienced by the patient.”
The paper relies on this without support.
Calprotectin is not specific to IBD and can be elevated in older age groups (age ≥45 years), obesity, infection, malignancy or by medications, such as proton pump inhibitors (PPIs) or non-steroidal anti-inflammatory drugs (NSAIDs).
“However, calprotectin is not specific to IBD and can be elevated in older age groups (age ≥45 years), obesity, infection, malignancy or by medications, such as proton pump inhibitors (PPIs) or non-steroidal anti-inflammatory drugs (NSAIDs).”
The paper relies on this without support.
The Rome IV criteria are the gold standard to define IBS for research purposes.
“Although the Rome IV criteria are the gold standard to define IBS for research purposes”
The authors state this as an assumption.
Some IBS symptoms are a result of gastrointestinal spasm and dysmotility, which antispasmodics ameliorate.
“The proposed mechanism of action of these agents is based on the assumption that some IBS symptoms are a result of gastrointestinal spasm and dysmotility, which antispasmodics ameliorate.217”
The paper relies on this without support.
In clinical practice, abdominal pain, bloating, nausea and constipation are common side effects of loperamide, and may limit tolerability.
“However, in clinical practice, abdominal pain, bloating, nausea and constipation are common side effects, and may limit tolerability.”
The paper relies on this without support.
Dysfunction within the bidirectional gut-brain axis plays an important role in the genesis and maintenance of symptoms in IBS.
“Dysfunction within the bidirectional gut-brain axis is considered to play an important role in the genesis and maintenance of symptoms in IBS.”
The paper relies on this without support.
There are often severity criteria built in, which aim to exclude the most severe or refractory symptoms, as well as less severe cases.
“There are often severity criteria built in, which aim to exclude the most severe or refractory symptoms, as well as less severe cases.”
The paper relies on this without support.
Many treatments are restricted to patients with IBS-C or IBS-D, whereas those with IBS-M or IBS-U are rarely recruited.
“many treatments are restricted to patients with IBS-C or IBS-D, whereas those with IBS-M or IBS-U are rarely recruited”
The paper relies on this without support.
Although there are established composite end points for IBS-C and IBS-D, these do not exist for IBS-M or IBS-U.
“although there are established composite end points for IBS-C and IBS-D, these do not exist for IBS-M or IBS-U”
The paper relies on this without support.
Recruitment to trials is optimal when patients are linked to specialist clinics.
“Second, recruitment to trials is optimal when patients are linked to specialist clinics.”
The paper relies on this without support.
Patients with IBS are widely disseminated, mostly in community care, often with no long-term follow-up, and only a minority attend specialist clinics where research is undertaken.
“However, patients with IBS are widely disseminated, mostly in community care, often with no long-term follow-up, and only a minority attend specialist clinics where research is undertaken.”
The paper relies on this without support.
The latter group (specialist clinic patients) is often more complex, more refractory and, by definition, less appropriate for treatment trials.
“This latter group is often more complex, more refractory and, by definition, less appropriate for treatment trials.”
The paper relies on this without support.
There are often too many visits, a need for invasive investigations, and a high burden of data collection.
“There are often too many visits, a need for invasive investigations, and a high burden of data collection.”
The paper relies on this without support.
Patients who enter IBS trials have usually tried all available treatments and remain unsatisfied with care, so being randomised to 'standard care' for ≥12 weeks is unappealing.
“Patients who enter IBS trials have usually tried all available treatments and remain unsatisfied with care, so being randomised to 'standard care' for ≥12 weeks is unappealing.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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 [10]
Experimental — accuracy not yet measured
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Papale, A., Flattau, R., Vithlani, N., Mahajan, D., & Nadella, S. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13226948 · Cited by 21
Update on gut microbiota in gastrointestinal diseases
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Self-citationEfficacy and safety of probiotics in irritable bowel syndrome: A systematic review and meta-analysis
Yang, R., Jiang, J., Ouyang, J., Zhao, Y., & Xi, B. (2024) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2024.02.025 · Cited by 22
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“20 It is the responsibility of the medical physician, be that in primary or secondary care, to clinically assess patients, undertake simple investigations, screen for high-risk features that may warrant more comprehensive investigation, and ultimately con fi rm and con fi dently convey the diagnosis.”
BackgroundMicrobial inulinase promotes fructan hydrolysis under simulated gastric conditions
Guice, J. L., Hollins, M. D., Farmar, J. G., Tinker, K. M., & Garvey, S. M. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1129329 · Cited by 21
“The low FODMAP diet also carries a burdensome requirement for implementation by a trained dietetic specialist (31).”
BackgroundImpact of Enteric Nervous Cells on Irritable Bowel Syndrome: Potential Treatment Options
Pastras, P., Aggeletopoulou, I., & Triantos, C. K. (2024) · Microorganisms · doi:10.3390/microorganisms12102036 · Cited by 18
“A low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet is highly recommended, supported by recent randomized controlled trials and meta-analyses [56,119–121].”
BackgroundGut‐Directed Hypnotherapy for Irritable Bowel Syndrome: A Systematic Review and Meta‐Analysis
Adler, E. C., Levine, E. H., Ibarra, A. N., Boparai, E. S., Hung, Y., McCrary, Q. D., & Lee, J. K. (2025) · Neurogastroenterology & Motility · doi:10.1111/nmo.70037 · Cited by 20
Bao, W., Li, Q., Bao, Y., Wang, S., & Li, W. (2022) · Frontiers in Pharmacology · doi:10.3389/fphar.2022.900788 · Cited by 20
“In addition to drug therapy, several therapies can alleviate the symptoms of IBS, including dietary adjustment, and psychological and behavioral therapy (Vasant et al., 2021).”
BackgroundMethodInfluentialDiagnostic management of patients reporting symptoms after wheat ingestion
Costantino, A., Aversano, M. G., Lasagni, G., Smania, V., Doneda, L., Vecchi, M. L., Roncoroni, L., Pastorello, E. A., & Elli, L. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.1007007 · Cited by 19
“When wheat-sensitive IBS is suspected, also non-diet specific treatments should be considered, such as neuromodulators, probiotics, and physical activity (84, 89, 90).”
BackgroundKuźmin, L., Kubiak, K., & Lange, E. (2025) · Nutrients · doi:10.3390/nu17122045 · Cited by 17
Sasegbon, A., Luo, Y., Keefer, L., & Vasant, D. H. (2023) · Neurogastroenterology & Motility · doi:10.1111/nmo.14649 · Cited by 18
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Microbiota modulation in disorders of gut-brain interaction
Marasco, G., Cremon, C., Barbaro, M. R., Bianco, F., Stanghellini, V., & Barbara, G. (2024) · Digestive and Liver Disease · doi:10.1016/j.dld.2024.05.004 · Cited by 20
The Latest Data Concerning the Etiology and Pathogenesis of Irritable Bowel Syndrome
Ionescu, V. A., Gheorghe, G., Georgescu, T. F., Bacalbaşa, N., Gheorghe, F., & Diaconu, C. C. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13175124 · Cited by 22
“The most important pathophysiological mechanisms involved in the development of IBS are presented in Figure 1 [30–32]. rate, IgA anti-tissue transglutaminase antibodies and total IgA, thyroid-stimulating hormone (TSH), and in patients with diarrhea, fecal calprotectine [23,24].”
BackgroundHerekar, A., Shimoga, D., Jehangir, A., Shahsavari, D., Yan, Y., Karunaratne, T. B., & Sharma, A. (2023) · Clinical and Experimental Gastroenterology · doi:10.2147/ceg.s384251 · Cited by 16
“It has also been recommended as an efficacious second line drug for IBS-C by British Society of Gastroenterology.22 Due to its effect on colonic hypersensitivity, it can reduce abdominal bloating, second most https://doi.org/10.2147/CEG.S384251 DovePress Clinical and Experimental Gastroenterology 2023:16 82 Powered by…”
BackgroundInfluentialTopan, R., Pandya, S., Williams, S., Ruffle, J. K., Zárate-López, N., Aziz, Q., & Fikree, A. (2023) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000002586 · Cited by 19
Evidence-Based Clinical Guidelines for Chronic Diarrhea 2023
Ihara, E., Manabe, N., Ohkubo, H., Ogasawara, N., Ogino, H., Kakimoto, K., Kanazawa, M., Kawahara, H., Kusano, C., Kuribayashi, S., et al. (2024) · Digestion · doi:10.1159/000541121 · Cited by 15
“…a treatment for IBS in particular, the validity of probiotics has been shown because of their effectiveness in improving symptoms and the low incidence of adverse events [124], and they are also highly recommended in clinical guidelines for IBS 2020 from the Japan Society of Gastroenterology [125].”
Pre-diagnostic faecal calprotectin levels in patients with colorectal cancer: a retrospective study
Blad, N., Palmqvist, R., & Karling, P. (2022) · BMC Cancer · doi:10.1186/s12885-022-09440-4 · Cited by 19
“The cut-off level of ≥ 100 μg/g which is standard to use in clinical practice [16].”
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Gut Non-Bacterial Microbiota: Emerging Link to Irritable Bowel Syndrome
Liu, A., Gao, W., Zhu, Y., Hou, X., & Chu, H. (2022) · Toxins · doi:10.3390/toxins14090596 · Cited by 18
“[4], but their efficacy remains unsatisfactory.”
BackgroundVolatile organic compounds as potential biomarkers of irritable bowel syndrome: A systematic review
Zhang, V. R., Ramachandran, G. K., Loo, E. X. L., Soh, A. Y. S., Yong, W. P., & Siah, K. T. H. (2023) · Neurogastroenterology & Motility · doi:10.1111/nmo.14536 · Cited by 16
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“IBS management includes diet and lifestyle modifications, pharmacotherapy, or psychological treatment [8–10].”
BackgroundKhasawneh, M., Craig, O. F., Gracie, D. J., Black, C. J., & Ford, A. C. (2023) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2023.05.022 · Cited by 21
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Self-citationThe Mediterranean Diet for Irritable Bowel Syndrome
Bamidele, J. O., Brownlow, G., Flack, R. M., Buckle, R. L., Shaw, C. C., Shiha, M. G., & Aziz, I. (2025) · Annals of Internal Medicine · doi:10.7326/annals-25-01519 · Cited by 23
Self-citationHow to Approach a Patient with Difficult-to-Treat IBS
Chang, L. (2021) · Gastroenterology · doi:10.1053/j.gastro.2021.07.034 · Cited by 15
Clinical outcome of disorders of gut‐brain interaction in secondary care: A longitudinal study
Chuah, K. H., Hian, W. X., Teoh, A. T., Ling, J. K. Y., & Mahadeva, S. (2023) · Neurogastroenterology & Motility · doi:10.1111/nmo.14602 · Cited by 16
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“, wheat bran) were not of significant and even caused abdominal bloating.(24) Living in a rural area and working in certain jobs are also modifiable risk factors for IBS.”
BackgroundLet food be your medicine – dietary fiber
Liu, M., Li, S., Cao, S., Liu, C., Han, Y., Cheng, J., Zhang, S., Zhao, J., & Shi, Y. (2024) · Food & Function · doi:10.1039/d3fo05641d · Cited by 17
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Self-citationEvaluation of the efficacy of probiotics as treatment in irritable bowel syndrome
Ruiz-Sánchez, C., Escudero‐López, B., & Fernández‐Pachón, M. (2024) · Endocrinología Diabetes y Nutrición (English ed ) · doi:10.1016/j.endien.2024.01.003 · Cited by 14
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“[13] At present, the treatment of IBS is primarily based on drugs and concurrent methods, including diet adjustments, psychotherapy, and appropriate exercise.[14] In basic clinical research, tricyclic antidepressants and psychological intervention can effectively improve the symptoms of IBS.”
BackgroundPost-COVID-19 and Irritable Bowel Syndrome: A Literature Review
Paramythiotis, D., Karlafti, E., Didagelos, M., Fafouti, M. E., Veroplidou, K., Protopapas, A. A., Kaiafa, G. D., Netta, S., Michalopoulos, A., & Savopoulos, C. G. (2023) · Medicina · doi:10.3390/medicina59111961 · Cited by 15
“Second-line drugs are the treatment option in the case of no improvement in symptoms [63].”
BackgroundLusetti, F., Schiepatti, A., Scalvini, D., Maimaris, S., & Biagi, F. (2024) · Nutrients · doi:10.3390/nu16071094 · Cited by 16
“…of CD should be excluded [6,8–10,14 ,15 Irritable bowel syndrome (IBS) is a common chronic functional disorder with an estimated prevalence of 4–11% worldwide [16], characterized by symptoms such as abdominal pain, diarrhoea, constipation, bloating, which often overlap with symptoms of CD [16–19].”
BackgroundGut-directed hypnosis and hypnotherapy for irritable bowel syndrome: a mini-review
Häuser, W. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1389911 · Cited by 17
“Current guidelines (Germany, Great Britain, United States) (Lacy et al., 2021; Layer et al., 2021; Vasant et al., 2021) recommend a graduated and tailored (according to symptoms) management approach (see Table 1).”
BackgroundInfluentialMurray, H. B., Guadagnoli, L. A., Kamp, K., Trindade, I. A., Powell, L. H., Simrén, M., Ljótsson, B., & Keefer, L. (2025) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.18482 · Cited by 14
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“It should be highlighted that, according to all guidelines [45,46], the diagnosis of IBS should be made through a positive approach, which would help to reduce the consumption of healthcare resources.”
BackgroundAGA Institute Quality Indicator Development for Irritable Bowel Syndrome
Hung, K. W., Leiman, D. A., Kaza, A., Watson, R. R., Chang, L., & Maratt, J. K. (2025) · Gastroenterology · doi:10.1053/j.gastro.2024.11.003 · Cited by 19
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Non-pharmaceutical treatments for irritable bowel syndrome
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Common misconceptions and controversies in the management of irritable bowel syndrome
Black, C. J., Olano, C., Quigley, E. M. M., & Ford, A. C. (2025) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-025-01065-9 · Cited by 13
“Data from RCTs suggest efficacy for glucagon-like peptide 1 receptor agonists in BAD 35,36 , although this success might be due to their retardation of gastrointestinal transit 35 .”
InfluentialSelf-citationDeveloping sensor materials for screening intestinal diseases
Zhao, C., Zhang, X., Chen, G., & Shang, L. (2022) · Materials Futures · doi:10.1088/2752-5724/ac48a3 · Cited by 12
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Self-citationFunctional Foods and Nutraceuticals in Irritable Bowel Syndrome
Marasco, G., Cremon, C., Salvi, D., Meacci, D., Dajti, E., Colecchia, L., Barbaro, M. R., Stanghellini, V., & Barbara, G. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14061830 · Cited by 15
“Peppermint oil has strong evidence supporting its use, earning a recommendation in European and American IBS guidelines [8–12].”
Iovino, P., Neri, M., d'Alba, L., Santonicola, A., & Chiarioni, G. (2021) · Neurogastroenterology and Motility · doi:10.1111/nmo.14264 · Cited by 8
Potential of natural products in the treatment of irritable bowel syndrome
Lü, Q., Tan, D., Luo, J., Ye, Y., Zuo, M., Wang, S., & Li, C. (2022) · Phytomedicine · doi:10.1016/j.phymed.2022.154419 · Cited by 12
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“…Administration (SAMHSA) [26], and American Psychiatric Association (APA) [27] for mental health; the British Society of Gastroenterology (BSG) [28], American College of Gastroenterology (ACG) [29], and Canadian Association of Gastroenterology (CAG) [30] for nutrition; the American College of…”
Biopsychosocial Aspects of Adult and Pediatric Disorders of Gut–Brain Interaction
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Clinical Trial: Rifaximin Versus Low FODMAP Diet in Irritable Bowel Syndrome
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Chuah, K. H., Black, C. J., Tee, V., Lim, S., Hian, W. X., Sahran, N., Lee, Y. Y., Mahadeva, S., & Ford, A. C. (2023) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.17567 · Cited by 11
Self-citationDimidi, E., McArthur, A. J., White, R., Whelan, K., & Lomer, M. C. E. (2023) · Neurogastroenterology & Motility · doi:10.1111/nmo.14640 · Cited by 12
“4,8,12,14 However, the unprecedented demand for dietitians to advise on the low FODMAP diet has created challenges to delivering on this recommendation.”
BackgroundInfluentialSleep: An Overlooked Lifestyle Factor in Disorders of Gut-Brain Interaction
Topan, R., & Scott, S. M. (2023) · Current Treatment Options in Gastroenterology · doi:10.1007/s11938-023-00433-1 · Cited by 11
“In the recently published British Society of Gastroenterology guidelines for IBS [13], first-line management is simple lifestyle advice.”
Willingness to pay for medications among patients with Rome IV Irritable Bowel Syndrome
Goodoory, V. C., Ng, C. E., Black, C. J., & Ford, A. C. (2022) · Neurogastroenterology & Motility · doi:10.1111/nmo.14483 · Cited by 9
Self-citationMartin, L. D., Fikree, A., Zárate-López, N., Martinkova, K., Brugaletta, C., Perrin, C., & Philpot, U. (2025) · Neurogastroenterology & Motility · doi:10.1111/nmo.70043 · Cited by 10
“However, the use of ONS is part of guideline management for functional dyspepsia [18, 22], although not for IBS [23, 24].”
Ye, J., Sun, H., Zhang, Q., He, J., & Zhou, M. (2025) · Nature Communications · doi:10.1038/s41467-025-62360-2 · Cited by 9
Systematic Review: Integrated Models of Care for Managing Irritable Bowel Syndrome
Warner, M. M., Soliman, O. M., Crichton, M., Marshall, S., Staudacher, H. M., & Kelly, J. T. (2025) · Neurogastroenterology & Motility · doi:10.1111/nmo.14989 · Cited by 9
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Who uses probiotics and why? A survey study conducted among general gastroenterology patients
Lynch, E., Troob, J., Lebwohl, B., & Freedberg, D. E. (2021) · BMJ Open Gastroenterology · doi:10.1136/bmjgast-2021-000742 · Cited by 11
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“In contrast to the AGA recommendations, the BSG state that probiotics, as a group, may be an effective treatment for global symptoms and abdominal pain in IBS.”
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The challenges of implementing evidence‐based therapy for irritable bowel syndrome in Asia
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The Potential Role of Human Milk Oligosaccharides in Irritable Bowel Syndrome
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“British Society of Gastroenterology guidelines on the management of IBS suggest that the NICE definition of IBS may be more suitable in a primary care setting, whereas Rome criteria may be better suited in secondary care [16].”
BackgroundDiet-microbiota interaction in irritable bowel syndrome: looking beyond the low-FODMAP approach
Dale, H. F., Lorentzen, S. S., Mellin-Olsen, T., & Valeur, J. (2023) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365521.2023.2228955 · Cited by 12
“There is currently a guideline consensus that diet and life-style modifications should be recommended as the first-line approach in the management of IBS [2,73,74].”
BackgroundThe role of Weizmannia (Bacillus) coagulans LMG S-31876 in treating IBS-diarrhea
Kallur, R. K., Madapati, S., Mathur, A., & Bhattacharya, S. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1310462 · Cited by 9
Irritable Bowel Syndrome: Current Landscape of Diagnostic Guidelines and Therapeutic Strategies
Chuy, D. S., Wi, R. S. K., & Tadros, M. S. (2024) · Gastroenterology Insights · doi:10.3390/gastroent15030056 · Cited by 9
Dong, Z., Wang, X., Xuan, L., Wang, J., Zhan, T., Chen, Y., Xu, S., & Ji, D. (2025) · BMC Gastroenterology · doi:10.1186/s12876-025-03919-7 · Cited by 8
“Some neuromodulators targeting the brain-gut axis were beneficial in relieving abdominal symptoms in IBS patients [5].”
Silva, H., Porter, J. A., Barrett, J. S., Gibson, P. R., & Garg, M. (2025) · Neurogastroenterology & Motility · doi:10.1111/nmo.70116 · Cited by 8
Aumpan, N., Chonprasertsuk, S., Pornthisarn, B., Siramolpiwat, S., Bhanthumkomol, P., Issariyakulkarn, N., Gamnarai, P., Bongkotvirawan, P., Wongcha-um, A., Mahachai, V., et al. (2025) · Frontiers in Medicine · doi:10.3389/fmed.2025.1648944 · Cited by 8
Lambiase, C., Rettura, F., Sciumè, G. D., Tedeschi, R., Grosso, A., Cancelli, L., Bottari, A., Fornai, M., Antonioli, L., de Bortoli, N., et al. (2025) · Frontiers in Pharmacology · doi:10.3389/fphar.2025.1677037 · Cited by 8
Ke, H., Li, Z., Lin, Q., Shen, Z., Chen, Y., & Chen, J. (2023) · Frontiers in Medicine · doi:10.3389/fmed.2023.1166683 · Cited by 10
“Thus, neuromodulators and gut-brain behavioral therapies are recommended in IBS guidelines (50), but it is worth noting that trials involving these treatments have shown disappointing results in patients with IBD (50– 52).”
BackgroundDing, L., Duan, J., Yang, T., Yuan, M., Ma, A. H., & Qin, Y. (2025) · Frontiers in Nutrition · doi:10.3389/fnut.2024.1494118 · Cited by 14
Innovative concepts in diet therapies in disorders of gut–brain interaction
So, D., & Tuck, C. J. (2024) · JGH Open · doi:10.1002/jgh3.70001 · Cited by 8
“The shift toward a functional paradigm has been discussed in recent reviews 17,18,21 but not yet adopted in guidelines, 22 – 24 although functional effects beyond solubility are beginning to be recognized.”
BackgroundEffect of Thumbtack Needle on Functional Constipation: A Pragmatic Randomized Controlled Trial.
Li, D., Zhang, G.-L., Zhang, L.-X., Tang, Y., Wang, L., Xu, Y., Cao, J., Zhao, W.-Q., Zuo, G.-C., Li, H., et al. (2024) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2024.103069 · Cited by 8
Molino, S., Lellis, L. F. D., Morone, M. V., Cordara, M., Larsen, D. S., Piccinocchi, R., Piccinocchi, G., Baldi, A., Minno, A. D., El-Seedi, H. R., et al. (2025) · Nutrients · doi:10.3390/nu17030552 · Cited by 7
“This means that nutritional interventions need to be customised in a certain sense, and this is why in more severe cases loperamide is indicated for diarrhoea or polyethylene glycol in the case of constipation [35].”
Baghdadi, G., Feyzpour, M., Shahrokhi, S. A., Amiri, R., & Rahimlou, M. (2025) · Frontiers in Medicine · doi:10.3389/fmed.2025.1529374 · Cited by 8
Iribarren, C., Maasfeh, L., Öhman, L., & Simrén, M. (2022) · Gut Microbiome · doi:10.1017/gmb.2022.6 · Cited by 9
“Still, it is acknowledged that probiotics may be useful in select patients and that patient preference is important in the final decision of treatment regimen (Lacy et al., 2021; Su et al., 2020; Vasant et al., 2021).”
BackgroundBarberio, B., Fairbrass, K. M., Gracie, D. J., & Ford, A. C. (2023) · Neurogastroenterology & Motility · doi:10.1111/nmo.14713 · Cited by 7
“Although gut-brain behavioral therapies are a recommended part of IBS management, 33 as they have a confirmed benefit for the symptoms of IBS, 34 there have been fewer trials of these interventions in IBD.”
BackgroundSelf-citationClinical presentation of celiac disease in adult patients: current real-life experience
Rossi, R. E., Masoni, B., Zullo, A., Deo, D. D., Hassan, C., & Repici, A. (2024) · Internal and Emergency Medicine · doi:10.1007/s11739-024-03686-5 · Cited by 7
Lambiase, C., Rossi, A., Morganti, R., Cancelli, L., Grosso, A., Tedeschi, R., Rettura, F., Mosca, M., de Bortoli, N., & Bellini, M. (2024) · Nutrients · doi:10.3390/nu16193419 · Cited by 7
“Currently, international guidelines suggest making a positive diagnosis of IBS based mainly on symptoms and performing very few tests (in the absence of alarm features) [3,4].”
BackgroundMartin, L. D., & Patel, P. S. (2024) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.13381 · Cited by 7
Wright-Hughes, A. M., Ford, A. C., Alderson, S. L., Ow, P. L., Ridd, M. J., Foy, R., Bishop, F. L., Chaddock, M., Cook, H., Cooper, D., et al. (2024) · Health Technology Assessment · doi:10.3310/bfcr7986 · Cited by 7
Self-citationHoughton, L. A., Gao, S., Gilbert, S. A., Coffin, B., Simrén, M., Gale, J. D., & the A4451007 study investigators (2025) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.18487 · Cited by 7
Self-citationGao, Y., Borjihan, Q., Zhang, W., Li, L., Wang, D., Bai, L., Zhu, S., & Chen, Y. (2025) · Nutrients · doi:10.3390/nu17050801 · Cited by 8
“…have demonstrated that the pathogenesis of IBS could be associated with changes in the brain– gut axis, dysregulation of gut microbiota and immunity, abnormalities in gastrointestinal motility and intestinal permeability, visceral hypersensitivity, as well as social and psychological factors [4,5].”
Functional Abdominal Cramping Pain
Müller-Lissner, S. A., Andresen, V., Corsetti, M., Fernández, L. B., Forestier, S., Pace, F., & Valdovinos, M. A. (2022) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000001764 · Cited by 8
“Types of antispasmodic medications, which are available as over-the-counter or prescription only products, depending on the market, include (1) antimuscarinics, for example, hyoscine butylbromide, dicycloverine hydrochloride (dicyclomine), and cimetropium; (2) the phosphodiesterase inhibitors drotaverine and papaverin…”
BackgroundSelf-citationManaging pain in irritable bowel syndrome: current perspectives and best practice
Algera, J. P., Lövdahl, J., Sjölund, J., Tornkvist, N. T., & Törnblom, H. (2023) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2023.2242775 · Cited by 10
“From this, it will not be considered as a realistic long-term treatment for the abdominal pain associated with IBS [34].”
Metadata
- Authors
- Vasant, D. H., Paine, P. A., Black, C. J., Houghton, L. A., Everitt, H. A., Corsetti, M., Agrawal, A., Aziz, I., Farmer, A. D., Eugenicos, M. P., Moss-Morris, R., Yiannakou, Y., & Ford, A. C.
- Affiliations
- University of Manchester (GB)
- Salford Royal NHS Foundation Trust (GB)
- University of Leeds (GB)
- University of Southampton (GB)
- University of Nottingham (GB)
- Bassetlaw Hospital (GB)
- Sheffield Teaching Hospitals NHS Foundation Trust (GB)
- University Hospitals of North Midlands NHS Trust (GB)
- Western General Hospital (GB)
- King's College London (GB)
- National Health Service (GB)
- Corresponding author
- Ford, Alexander C
- ORCID
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2021-04-26
- Volume
- 70
- Issue
- 7
- Pages
- 1214-1240
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- OpenAlex
- W3159143441
- Cited by
- 592
- References
- 309
- Citations by year
- 2026: 138 · 2025: 135 · 2024: 107 · 2023: 105 · 2022: 80 · 2021: 25
- FWCI
- 56.17
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gut (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Repository@Nottingham (University of Nottingham) (acceptedVersion, other-oa)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by-nc)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Funders
- Nottingham University Hospitals NHS Trust
- National Institute for Health and Care Research (11/69/02)
- University of Nottingham
- NIHR Nottingham Biomedical Research Centre
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Health and Development
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Keywords
- irritable bowel syndrome, gut-brain axis, IBS diagnosis, IBS management, dietary therapy, pharmacotherapy, psychotherapy, network meta-analysis, evidence-based recommendations
- MeSH terms
- Drug Development, Communication, Constipation, Diarrhea, Diet, United Kingdom, Humans, Hypnosis, Patient Education as Topic, Physician-Patient Relations, Serotonin Antagonists, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Probiotics, Biomedical Research, Irritable Bowel Syndrome
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