New guidelines on the use of medicines for irritable bowel syndrome from Atlanta Gastroenterology Association (AGA) have been published (Gastroenterol 2014; 1146-48, technical review: 1149-72).
Here’s the link: AGA IBS Guidelines.
In brief:
For IBS-C
- Linaclotide: AGA recommends as better than no drug treatment in adult. This is the only “strong” recommendation with high-quality evidence.
- Lubiprostone: AGA suggests over no drug treatment.
- PEG Laxatives: AGA suggests over no drug treatment.
For IBS-D:
- Rifaximin: AGA suggests over no drug treatment.
- Alosetron: AGA suggests over no drug treatment.
- Loperamide: AGA suggests over no drug treatment.
For IBS:
- Tricyclic antidepressants: AGA suggests over no drug treatment.
- Selective Serotonin Reuptake Inhibitors: AGA suggests against using for IBS.
- Antispasmotics: AGA suggests over no drug treatment.
Also noted:
Am J Gastroenterol 2014; 109: 1547-61. (Thanks to Ben Gold for this reference.) Meta-analysis of prebiotics/probiotics for IBS. 43 RCTs were eligible for inclusion. Key finding: IBS symptoms, including pain, bloating and flatulence were improved with RR of 0.79 compared with placebo. “Probiotics are effective treatments for IBS, although which individual species and strains are the most beneficial remains unclear.”
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