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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.

Zelnorm is a medication for constipation predominant IBS (IBS-C) that is returning to the market in the US after it was off the market for some years. It was re-approved early this year by the FDA and is now in pharmacies again. Zelnorm works differently than other medications for constipation. It increases the amount of serotonin in the gut in order to cause a bowel movement and relieve abdominal pain. More information about Zelnorm can be found here. Is there anyone who has been able to try Zelnorm (tegaserod) again for constipation predominant IBS (IBS-C)? I would be interested to know if it is working for you like it did when it was on the market before. or What was the perspective you had when you last used Zelnorm before it was removed from the market?

We are heading to the US FDA in Washington DC/Bethesda on Wednesday and Thursday to testify on behalf of patients for IBS and constipation medications that could help some patients. Zelnorm was well loved by IBS-C patients. Prucalopride is widely used outside the US for constipation. Our presentations are posted. Thank you to those people that helped with some of the quotes and for completing the survey. Zelnorm: https://www.regulations.gov/document?D=FDA-2018-N-3223-0009 Prucalopride: https://www.regulations.gov/document?D=FDA-2018-N-0055-0013