British Society of Gastroenterology guidelines on the management of irritable bowel syndrome

Abstract

Irritable bowel syndrome (IBS) remains one of the most common gastrointestinal disorders seen by clinicians in both primary and secondary care. Since publication of the last British Society of Gastroenterology (BSG) guideline in 2007, substantial advances have been made in understanding its complex pathophysiology, resulting in its re-classification as a disorder of gut-brain interaction, rather than a functional gastrointestinal disorder. Moreover, there has been a considerable amount of new evidence published concerning the diagnosis, investigation and management of IBS. The primary aim of this guideline, commissioned by the BSG, is to review and summarise the current evidence to inform and guide clinical practice, by providing a practical framework for evidence-based management of patients. One of the strengths of this guideline is that the recommendations for treatment are based on evidence derived from a comprehensive search of the medical literature, which was used to inform an update of a series of trial-based and network meta-analyses assessing the efficacy of dietary, pharmacological and psychological therapies in treating IBS. Specific recommendations have been made according to the Grading of Recommendations Assessment, Development and Evaluation system, summarising both the strength of the recommendations and the overall quality of evidence. Finally, this guideline identifies novel treatments that are in development, as well as highlighting areas of unmet need for future research.

Strain-specific and outcome-specific efficacy of probiotics for the treatment of irritable bowel syndrome: A systematic review and meta-analysis

“…The pathophysiology of IBS involves chronic mucosal inflammation, alterations in intestinal epithelial and immune functions, visceral hypersensitivity, increased intestinal permeability and dysbiosis of the intestinal microflora. Treatment guidelines recommend medications focused on IBS symptoms, diets low in fermentable types of oligosaccharides, rifaximin and the use of probiotics [ 3 , 4 ]. Choosing an appropriate probiotic for patients can be challenging due to the diversity of different types of available probiotics, efficacy is strain-specific and the paucity of randomized clinical trials for some probiotic strains [ 5 , 6 ].…”

Recent advances in the treatment of irritable bowel syndrome

“…3, 24 Hence, soluble fiber should be preferred, initially at a low -dose (3-4 g/day) and built up gradually to avoid bloating. 21 Fat intake has shown to worsen diarrhea in patients with IBS -D and increased carbohydrate intake is correlated with exacerbation of IBS symptoms. 15 Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs), such as fructans, galactans, favoring FMT.…”

“…The recently published British Society of Gastroenterology guidelines highlight that dietary advice should be considered a first -line approach, with strong recommendation and weak quality of evidence. 21 The traditional dietary advice recommended by the National Institute for Health and Care Excellence for patients with IBS include nonpharmacological approaches and should be based on the prevalent symptomatology. In this review, we will discuss the recent therapeutic advances and pathogenetic backgrounds of the 3 main symptoms of IBS: diarrhea, constipation, and abdominal pain.…”

“…27 Currently, LFD is recommended as a second -line dietary approach. 21 Patients with IBS can experience worsening of symptoms after intake of lactose or gluten. The role of lactose intolerance in IBS is controversial 3 : compared to the general population, patients with IBS more often report symptoms related to lactose malabsorption, despite similar rates of hydrogen positivity on breath test.…”

“…The recent guidelines on IBS management suggest to try this approach for 12 weeks and discontinue in case of lack of improvement (level of recommendation, weak; quality of evidence, very low). 21 As far as FMT is concerned, it is currently approved for resistant Clostridium difficile infection, in which it was shown to be an effective therapy, 38 while its application in IBS has shown conflicting results. In an RCT including 90 patients with IBS -D or IBS -M, FMT performed in 55 patients through colonoscopy showed a significant clinical efficacy compared with placebo.…”