Irritable Bowel Syndrome Guideline Update Released

By Jessica Pyhtila, PharmD, BCGP, BCPS

The British Society of Gastroenterology recently published an update to their 2007 guideline for irritable bowel syndrome (IBS).

The guidelines state that in a primary care setting, the diagnosis of IBS may be made after 6 months of abdominal pain or discomfort, along with altered bowel habits, in the absence of alarm symptoms like weight loss or rectal bleeding. Further, the guidelines urge that clinicians follow guidelines for colorectal cancer screening. During an initial work-up in a primary care setting, the guidelines recommend labs including:

— Complete blood count

— C reactive protein or erythrocyte sedimentation rate

— Celiac serology

— Fecal calprotectin in patients with diarrhea under the age of 45 years of age with diarrhea

In the presence of IBS symptoms, a diagnosis of IBS can be made based on labs. If a second opinion is desired, or if the patient has severe symptoms, a referral to a gastroenterologist can be made.

The guidelines made recommendations about IBS treatments. These include both pharmacologic and non-pharmacologic first-line therapies such as:

— Regular exercise

— Soluble fiber, starting at a dose of 3 to 4 grams daily

— Dietitian referral to oversee implementation of a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols

— Probiotics, noting that no specific species or strain is recommended

— Loperamide for diarrhea

— Antispasmodics for abdominal pain

— Peppermint oil for abdominal pain

— Polyethylene glycol for constipation

The guidelines recommend against food elimination diets based on IgG antibodies, insoluble fiber, a gluten-free diet. However, they go on to recommend a variety of second-line pharmacotherapies. In addition, psychological treatments such as cognitive behavioral therapy and gut-directed hypnotherapy may be considered, especially if the patient has not improved after 12 months of treatment.

References

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