The new guidelines published on December 14 in the American Journal of Gastroenterology, identify 25 important questions that doctors frequently ask patients. It then uses the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to evaluating the data. The hope, the guideline authors wrote, is to help get better, more targeted care to patients with IBS.
These aren’t the first-ever guidelines on how to care for patients with IBS—those came out in 2014, guidelines co-author Darren Brenner, MD, a gastroenterologist at the Digestive Health Center at Northwestern Memorial Hospital, tells Verywell. However, this is the first time the GRADE system has been used. “This is a high-level advanced methodology to assess the rigor of clinical trials that have been done to date,” he says.
New Guidelines
The guidelines specify treatments and diagnostic studies that may be helpful for any particular patient, Brenner explains. “We’re hoping it will streamline the process for practitioners and shorten the time to appropriate therapy for patients,” he says.
The guidelines include the following, and more:
Diagnostic testing to rule out celiac disease and inflammatory bowel disease (IBD) in patients with suspected IBS and diarrhea, which is not routinely performed by many healthcare providersRecommendations against routine colonoscopy in patients with IBS symptoms under age 45 who do not have warning signs like unintentional weight loss, older age of onset of symptoms, or family history of IBD, colon cancer, or other significant gastrointestinal diseasesTreatment of IBS with constipation (IBS-C) symptoms with guanylate cyclase activators and treatment of IBS with diarrhea (IBS-D) symptoms with a gut-selective antibioticThe use of tricyclic antidepressants to treat global symptoms of IBS, including abdominal painGut-directed psychotherapies to treat overall IBS symptoms as part of a comprehensive management strategy, rather than as a last resort, that can be used in conjunction with dietary therapies and medications
Currently, IBS is diagnosed by process of elimination but Brenner says he and his colleagues are hoping to change that. “Most people with IBS undergo extensive testing before they’re diagnosed which is many times unnecessary,” he says. These tests can include blood tests, stool tests, a hydrogen breath test, an upper GI endoscopy, and a colonoscopy, the NIDDK says.
The guidelines also give recommendations on the types of treatments that may be more effective than others. “We want to give the treatments that will work best, and we say what is unlikely to work for a profile as well,” Brenner says.
“I think this is a great tool,” Ashkan Farhadi, MD, a gastroenterologist at MemorialCare Orange Coast Medical Center in California, who was not involved in creating the guidelines, tells Verywell. “This should help streamline the process of diagnosing patients—it can be very uncoordinated, doing different tests by different doctors.”
The challenge, Farhadi says, is whether medical professionals will actually start to use these guidelines. “Whether they will take advantage of this or shelve it, that needs to be seen,” he says.
Brenner hopes the guidelines will help improve the quality of life for people who struggle with IBS. “Quality of life is linked to symptoms,” he says. “If we can better treat them and give better evidence-based treatment, it will significantly improve quality of life.”
