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AGA Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome With Diarrhea Anthony Lembo,1,* Shahnaz Sultan,2,3,* Lin Chang,4 Joel J. Heidelbaugh,5 Walter Smalley,6 and G. Nicholas Verne7 1Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; 2Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota; 3Veterans Affairs Healthcare System, Minneapolis, Minnesota; 4Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California; 5Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan; 6Division of Gastroenterology, Vanderbilt University School of Medicine, Nashville, Tennessee; and 7Department of Medicine, University of Tennessee College of Medicine, Memphis, Tennessee Background & Aims Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder associated with significant disease burden. This American Gastroenterological Association Guideline is intended to support practitioners in decisions about the use of medications for the pharmacological management of IBS with predominant diarrhea (IBS-D) and is an update of a prior technical review and guideline. Methods The Grading of Recommendations Assessment, Development and Evaluation framework was used to assess evidence and make recommendations. The technical review panel prioritized clinical questions and outcomes according to their importance for clinicians and patients and conducted an evidence review of the following agents: eluxadoline, rifaximin, alosetron, loperamide, tricyclic antidepressants, selective serotonin reuptake inhibitors, and antispasmodics. The guideline panel reviewed the evidence and used the Evidence-to-Decision Framework to develop recommendations. Conclusions The panel agreed on 8 recommendations for the management of patients with IBS-D. The panel made conditional recommendations for eluxadoline, rifaximin, alosetron, (moderate certainty), loperamide (very low certainty), tricyclic antidepressants, and anstispasmodics (low certainty). The panel made a conditional recommendation against the use of selective serotonin reuptake inhibitors (low certainty). >> View the full guideline >> View a PDF of the guideline Copyright © 2022 Elsevier Inc. except certain content provided by third parties.

AGA Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome With Constipation Lin Chang,1,*Shahnaz Sultan,2,3,*Anthony Lembo,4 G. Nicholas Verne,5 Walter Smalley,6 and Joel J. Heidelbaugh7 1Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California; 2Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota; 3Veterans Affairs Healthcare System, Minneapolis, Minnesota; 4Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; 5Department of Medicine, University of Tennessee College of Medicine, Memphis, Tennessee; 6Department of Medicine, Division of Gastroenterology, Vanderbilt University, Nashville, Tennessee; and 7Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan Background & Aims Irritable bowel syndrome (IBS) is a common disorder of gut–brain interaction associated with significant disease burden. This American Gastroenterological Association guideline is intended to support practitioners in decisions about the use of medications for the pharmacological management of IBS-C and is an update of a prior technical review and guideline. Methods The Grading of Recommendations Assessment, Development and Evaluation framework was used to assess evidence and make recommendations. The technical review panel prioritized clinical questions and outcomes according to their importance for clinicians and patients and conducted an evidence review of the following agents: tenapanor, plecanatide, linaclotide, tegaserod, lubiprostone, polyethylene glycol laxatives, tricyclic antidepressants, selective serotonin reuptake inhibitors, and antispasmodics. The Guideline Panel reviewed the evidence and used the Evidence-to-Decision Framework to develop recommendations. Conclusions The panel agreed on 9 recommendations for the management of patients with IBS-C. The panel made a strong recommendation for linaclotide (high certainty) and conditional recommendations for tenapanor, plecanatide, tegaserod, and lubiprostone (moderate certainty), polyethylene glycol laxatives, tricyclic antidepressants, and antispasmodics (low certainty). The panel made a conditional recommendation against the use of selective serotonin reuptake inhibitors (low certainty). >> View the full guideline >> View a PDF of the guideline Copyright © 2022 Elsevier Inc. except certain content provided by third parties.

New report reveals that more than one-third of IBS Patients surveyed state it has been more challenging to manage their symptoms during the COVID-19 pandemic. Salix released a report of survey results that offers perspectives from U.S. adults living with irritable bowel syndrome (IBS) during the COVID-19 pandemic. Entitled, Patient Perspectives: Living with IBS in a Pandemic, the report provides insights about the symptoms and behaviors of IBS patients over the past year (March 2020 – March 2021). Most notably, more than one-third (37%) of those surveyed acknowledge that the COVID-19 pandemic has made it more challenging to manage their IBS symptoms. The report, which was developed based on a survey conducted by The Fairleigh Dickinson University Poll, also finds concerns about post-pandemic life and insights about the way patients are communicating with their health care providers. “It’s been just over a year since the COVID-19 pandemic upended lives across the nation. Salix is committed to helping patients with GI conditions, and we believe it is important to gain an understanding of how the COVID-19 pandemic may impact people living with IBS, a common gastrointestinal disorder that is estimated to affect more than 12 million Americans1,” said Robert Spurr, president, Salix Pharmaceuticals. “We believe these new insights may foster important dialogue between health care providers and their patients.” Key findings from the report include: The pandemic is impacting the wellbeing of IBS patients with 49% reporting that their mental health has worsened. Of the respondents, 51% report worse physical activity and 34% state worse eating habits. Many respondents report deteriorating IBS symptoms. According to the survey, 33% report worsened diarrhea, 31% report worsened constipation, 39% report worsened abdominal pain or discomfort, and 42% report worsened bloating. Fewer than 15% of patients surveyed living with these symptoms report experiencing an improvement over the past year. 35% of respondents have not discussed their IBS symptoms with a health care provider at all since the COVID-19 pandemic began. Respondents express concerns about post-pandemic life, including lack of access to restrooms (55%) and being able to attend social gatherings (48%). >> To view the complete findings from the Patient Perspectives: Living with IBS in a Pandemic report, visit here. References 1. Palsson OS, Whitehead W, Törnblom H, Sperber AD, Simren M. Prevalence of Rome IV Functional Bowel Disorders Among Adults in the United States, Canada, and the United Kingdom. Gastroenterology. 2020 Apr;158(5):1262-1273.e3. doi: 10.1053/j.gastro.2019.12.021. Epub 2020 Jan 7. PMID: 31917991.

I've had so many ups and downs since (and even before) finding out I have IBS. Mostly, I would say that I have learned so, so much and for that I am grateful and I will always seek new information. Seeing myself through this lens has been eye-opening and it has made so many other things about myself and my experiences make sense. I've also found it helpful and cathartic to write things down. (And by "write down" I mean "type out".) Organizing my thoughts and expressing my feelings has helped me untangle parts of my mind and (thanks to the gut-brain axis) my gut has benefitted right along side it. It started as just a digital journal, but it has grown into a blog about my experiences and the helpful information I've found in my research on this journey. Not only has it helped me tremendously to put my thoughts down, but I know some others have reached out to me about how it has helped them too, which is truly humbling. Even if you're not interested in setting up a blog, I highly recommend writing down your thoughts and feelings somewhere. Maybe you keep a physical journal. Maybe you start up a document on your desktop or a note on your phone. Whatever gives you that feeling of letting it all flow and feeling the relief that washes over you when things start to make sense. Feel free to visit me at https://gut-vibes.com/ ! (Although, don't you worry. I'll still be here too. We've got to stick together after all!)

What is the first thing you do when you discover that you are having an IBS flare-up?