Since nearly everyone who experiences a spinal cord injury (SCI) experiences neurogenic bowel dysfunction (NBD), the information contained in this clinical practice guideline (CPG) is of great relevance both to the community of persons with SCI and to the clinicians who help them manage the secondary conditions of SCI, of which controlled NBD remains a major determinant of quality of life (QOL). This CPG, similar to its predecessor version, is anticipated to be one of the most important CPGs of the Consortium for Spinal Cord Medicine regarding potential impact on the care of persons with SCI. The scope of this most recent update has been expanded to include a review of the different types of oral and rectally administered medications, of procedures such as transanal irrigation, and of surgical options.During the development and peer review of this CPG, we were fortunate to have the representation of an international team of various stakeholders, including the subspecialties affected by these recommendations, ranging from experts in gastroenterology, gastrointestinal surgery, and nutrition to rehabilitation professionals, including physiatrists, nurses, psychologists, and occupational and physical therapists. We hope that this wide-ranging representation translates into uniform quality practice through the widespread use of this CPG to guide NBD in all settings, which can only result in the best outcomes and QOL for those who experience SCI.On behalf of the consortium steering committee, I want first to acknowledge the leadership of the Chair, Jeffery Johns, MD, in guiding this panel through the development process. Next, I would like to acknowledge the panel members themselves for keeping to task, as well as the many reviewers who provided valuable feedback from all areas and are to be commended. All of these people, including the panel Chair, have volunteered their time to help produce this superb document. In addition, I wish to acknowledge the ongoing support of the Paralyzed Veterans of America, especially President David Zurfluh, Executive Director Carl Blake, and Director of Research and Education Cheryl Vines, as well as the rest of the leadership team, without whose support these guidelines would not exist.Finally, we thank the Craig H. Neilsen Foundation and Executive Director Kym Eisner for their commitment to improving the QOL for those living with SCIs and for their generous financial support of this CPG.

These guidelines have been prepared based on scientific and professional information available in 2018. Users should periodically review this material to ensure that the advice herein is consistent with current reasonable clinical practice. The websites noted in this document were current at the time of publication; however, because web addresses and the information contained therein change frequently, the reader is encouraged to stay apprised of the most current information.

Irritable bowel syndrome (IBS) is the most prevalent of gastrointestinal (GI) conditions, affecting millions of people worldwide. Given that most IBS patients associate their GI symptoms with eating food, specific dietary manipulation has become an attractive treatment strategy. A diet low in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) has generated the greatest level of scientific and clinical interest. Overall, 52–86% of patients report significant improvement of their IBS symptoms with elimination of dietary FODMAPs. Patients who experience symptom improvement with FODMAP elimination should undergo a structured reintroduction of foods containing individual FODMAPs to determine sensitivities and allow for personalization of the diet plan. This review discusses the literature surrounding the administration of the low-FODMAP diet and its efficacy in the treatment of IBS.

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