Gastroenterology

Gastroenterology

Volume 163, Issue 1, July 2022, Pages 118-136
Gastroenterology

Guideline
AGA Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome With Constipation

https://doi.org/10.1053/j.gastro.2022.04.016Get rights and content

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).

Section snippets

Objective

Since the AGA published the first IBS technical review (TR) and guideline in 2014,16,17 new pharmacological treatments have become available and new evidence has accumulated about established treatments. The purpose of these guidelines is to provide updated evidence-based recommendations for the pharmacological management of individuals with IBS-C based on a systematic and comprehensive synthesis of the literature. In addition, we included recommendations for the following 3 classes of

Overview

This document represents the official recommendations of the AGA and was developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. and adheres to best practices in guideline development, as outlined by the National Academy of Medicine (formerly Institute of Medicine) previously. Development of this guideline was fully funded by the AGA Institute.18

Guideline Panel Composition and Conflict of Interest

Members of the guideline and TR panels were selected on the basis of their clinical and methodological

Recommendations

A summary of all the recommendations is provided in Table 1. A description of included studies is provided in Table 4 and an overview of the relative and absolute effect estimates for the critical outcomes is provided in Table 5. For all recommendations in this document, the pharmacological agent was compared with “no drug treatment.”

Acknowledgments

The authors sincerely thank Kellee Kaulback, Medical Information Officer, for helping in the literature search for the evidence review.

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  • Cited by (0)

    Correspondence Address correspondence to: Chair, Clinical Guidelines Committee, American Gastroenterological Association, National Office, 4930 Del Ray Avenue, Bethesda, Maryland 20814. e-mail: [email protected].

    Conflicts of interest These authors disclose the following: Lin Chang has served as a member of the scientific advisory boards for Ardelyx, Immunic, Ironwood Mauna Kea Technologies, and Protagonist. She has served as a consultant for Trellus and a speaker for Abbvie. She has received research support from the National Institute of Health, Arena, AnX Robotica, and Ironwood. She has stock options with ModifyHealth and Trellus. Anthony Lembo has served as a member of the scientific advisory board for Arena, Ardelyx, Bioamerica, IM HealthSciences, Mauno Kea Technologies, Ironwood, Mylan, Orpho-Med, Ritter, Shire, Takeda, Vibrant and Allergan. He has received research support for clinical trials from National Institute of Health, Arena, Takeda, Vanda, and Vibrant, and Vanda. The remaining authors disclose no conflicts.

    Funding G. Nicholas Verne is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (DK099052 and DK118959). Shahnaz Sultan is supported by the National Heart, Lung, and Blood Institute at the National Institute of Health for Asthma Guideline Development.

    This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e15. Learning Objective: Upon completion of this CME activity, successful learners will be able to identify pharmacologic treatment options for the management of individuals with IBS-C.

    Authors share co-first authorship.

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