Chang L, Sultan S, Lembo A, et al. AGA Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome With Constipation. Gastroenterology. 2022 Jul;163(1):118-136. doi: 10.1053/j.gastro.2022.04.016. (Evidence-based guideline)

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).

Discipline Area Score
Family Medicine (FM)/General Practice (GP) 6 / 7
General Internal Medicine-Primary Care(US) 6 / 7
Gastroenterology 6 / 7
Internal Medicine 5 / 7
Comments from MORE raters

Gastroenterology rater

There has been considerable advance in pharmacologic therapy for this condition, and so this guideline is both timely and informative.

Gastroenterology rater

Useful paper but it's a pity we cannot apply this information in some areas because the new drugs that help some patients have better quality-of-life are not available.

General Internal Medicine-Primary Care(US) rater

Primary care physicians deal with this every day. Some, including me, may find it difficult keeping up with the slew of new pharmaceuticals for this. This review/guideline may help. I am a little disappointed that the guideline was about expensive things first and cheap things second, which is probably a funding bias in that there is no money to be made in PEG and thus no company-supported studies to assess its effectiveness. For me, PEG still has to be among the first treatment options since it is cheap, possibly/probably effective, and we have so much experience with it we know what to expect.

Internal Medicine rater

A good example of the GRADE process in the synthesis of evidence summaries for the development of CPGs.
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