Evidence-Based Systematic Review on Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation
In order to evaluate the rapidly expanding research about Irritable Bowel Syndrome (IBS) and chronic idiopathic constipation (CIC) and to assess the evidence of efficacy of new IBS and constipation drugs, ACG sponsored an independent, systematic review of evidence about the management of IBS and CIC to update earlier reviews from 2009 and 2005 as a supplement to the August 2014 issue of The American Journal of Gastroenterology.
For the new American College of Gastroenterology Monograph on the Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation, all available studies were reviewed by the ACG Expert Task Force on the Management of Functional Bowel Disorders after a careful and systematic search of the literature in order to update the recommendations. This analysis will allow physicians to bring the latest evidence to bear on the care of their patients with IBS and CIC, and features new information for clinicians to consider when making recommendations about diet, probiotics, antibiotics, and antidepressants for IBS and the use of fiber, laxatives, and recently developed drugs—prucalopride, lubiprostone, and linaclotide for managing constipation. This review also summarizes information about the effectiveness of other therapies—alosetron, lubiprostone, and linaclotide— in treatment of IBS.
The quality of the evidence was graded by standard criteria and recommendations developed based on the quality of the evidence and additional factors such as risk, cost, and acceptability to patients.
The College’s new recommendations include updated information and expert assessments of traditional therapies for IBS and CIC, as well as a range of new treatment approaches, including evidence on diet; probiotics; the non-absorbable antibiotic rifaximin; antidepressants; antispasmodics and peppermint oil; fiber, bulking agents and laxatives; antidiarrheals, including loperamide; the 5-HT3 receptor antagonist alosetron; the 5-HT4 (serotonin) receptor agonist tegaserod; the chloride channel activator lubiprostone; psychological therapies such as hypnotherapy and biofeedback; herbal preparations and acupuncture.
This new meta-analysis of the literature on the management of IBS and chronic idiopathic constipation offers physicians scientifically-based guidance to make clinical decisions about these conditions based on a thorough assessment of the evidence.
ACG Expert Task Force on the Management of Functional Bowel Disorders
- Chair, Eamonn M. M. Quigley, MD, FRCP, FACG, Houston, Methodist Hospital and Weill Cornell Medical College
- Brian E. Lacy, MD, PhD, FACG, Dartmouth-Hitchcock Medical Center
- Anthony J. Lembo, MD, Harvard Medical School, Beth Israel Deaconess Medical Center
- Paul Moayyedi, BSc, MB, ChB, PhD, MPH, FRCP (London), FRCPC, FACG,* McMaster University Medical Centre
- Yuri Saito, MD, MPH, Mayo Clinic, Rochester
- Lawrence R. Schiller, MD, FACG, Baylor University Medical Center
- Edy E. Soffer, MD, FACG, Keck School of Medicine, University of Southern California
- Brennan M. R. Spiegel, MD, MSHS, UCLA School of Medicine
*Dr. Moayyedi conducted the systematic reviews with support from Alexander C. Ford, MD, ChB, MD, FRCP, and carried out the technical analyses of the data independent of the Task Force.
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