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  1. 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.
  2. 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.
  3. An updated American College of Gastroenterology (ACG) Guideline (2021) for IBS was just published. Among the 25 recommendations for IBS from the ACG are: Serologic testing should be performed to rule out celiac disease in patients with IBS and diarrhea symptoms. Fecal calprotectin, fecal lactoferrin and C-reactive protein should be checked in patients without alarm features and with suspected symptoms of IBS and diarrhea to rule out inflammatory bowel disease Routine stool testing should not be performed for enteric pathogens in all IBS patients. Routine colonoscopy should not be performed in patients with IBS symptoms aged younger than 45 years without warning signs. A positive diagnostic strategy vs. a diagnostic strategy of exclusion should be used for patients with IBS symptoms to improve time to initiate appropriate therapy and cost-effectiveness. Do not test for food allergies and sensitivities unless patients have reproducible symptoms concerning a food allergy. Limited trial of a low fermentable oligosaccharides, disacchardies, monosaccharides, polyols (FODMAP) diet in patients with IBS to improve global symptoms. Anorectal physiology testing should be performed in patients with IBS and symptoms that may suggest a pelvic floor disorder and refractory constipation. Anti-spasmodics available in the United States should be used to treat global IBS. Peppermint may be used to provide relief of global symptoms. Mixed opioid agonists/antagonists should be used to treat global IBS-D symptoms Use of chloride channel activators and guanylate cyclase activators (Linzess / Constella) to treat global IBS with constipation symptoms. Use of rifaximin (Xifaxan) to treat global IBS with diarrhea symptoms. Gut-directed psychotherapy (CBT) be used to treat global IBS symptoms. Source(s): Healio Pubmed: PMID: 33315591
  4. What motivates someone to take the step to see a healthcare professional about their digestive symptoms?
  5. Jeffrey Roberts

    IBS Flare-ups

    What is the first thing you do when you discover that you are having an IBS flare-up?
  6. American College of Gastroenterology (ACG) Monograph on Management of Irritable Bowel Syndrome Evidence-based systematic review on the management of IBS shows some surprises. Low FODMAP diet is weak, Fiber is high. Tricyclic antidepressants are high, Probiotics are weak. Full paper here: https://www.nature.com/articles/s41395-018-0084-x.epdf?shared_access_token=Kuvo7jISmRrYgasZhJ70ldRgN0jAjWel9jnR3ZoTv0NblxNI4GM_X5swCfsJBAT7UvHzDHjWesbivn8ON0dVQ9y2zptCP5VnnpcknLq0zHdIfUAo2EyN3Mxv5SDEA9-WYik6AWjeF_z_NmXSikThCEq6jaLaOdMyH-5TQGaalBY%3D
  7. April is IBS Awareness Month, a time to both raise awareness as to what it is like to live with IBS and a time for those who think they have IBS to seek a diagnosis and discuss treatment options with their physician. Many treatment options are available. You do not have to suffer silently alone. For IBS Awareness Month, IBS Patient is sharing their smartphone Restroom Access Card which can be used in the event that you need immediate access to a restroom. We support the initiative by Allyson Bain to make it easier for suffers to gain access to a restroom, via The Restroom Access Act. Follow these instructions to use the smart card on your smartphone: 1. On your smartphone browser (Safari on an iPhone, Chrome on Android), go to www.ibspatient.org/restroom-access-card 2. Turn your smartphone sideways after loading to see the complete restroom access card on the screen. 3. Bookmark this URL in your browser or take a picture of the screen so that you have the Restroom Access Card in your photo library.
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