IBS is a disorder affecting intestinal functioning and sensation, a condition in which people report changes in their intestinal behaviour, such as constipation or diarrhoea and stomach discomfort, along with other signs of abdominal bloating and rectal urgency of diarrhoea. According to Rome IV diagnostic guidelines, IBS is estimated to affect 4.4 to 4.8% of the population, most frequently women.

The first-ever scientific recommendations for the treatment of irritable bowel syndrome have been developed by the American College of Gastroenterology. The data presented in this article will guide both practitioners and researchers for years to come. Following are the salient features of the guideline:

Evaluation

• Serologic evaluation is done in people with IBS and diarrhoea, to rule out celiac disease
• In patients without warning features and with reported IBS and diarrhoea symptoms, faecal calprotectin (or faecal lactoferrin) and C-reactive protein should be tested to rule out inflammatory bowel disease
• Routine stool testing for enteric pathogens in all patients with IBS is not recommended
• Routine colonoscopy in patients with IBS symptoms <45 years age without warning signs is mot recommended
• Testing for food allergies and food sensitivities in all patients with IBS is not recommended unless there are reproducible symptoms concerning a food allergy
• Anorectal physiology testing is suggested in patients with IBS and symptoms suggestive of a pelvic floor disorder and/or refractory constipation not responsive to standard medical therapy

Diagnosis

• A positive diagnostic strategy is preferred to a diagnostic strategy of exclusion for patients with symptoms of IBS to enhance the time needed to begin effective treatment and develop cost-effectiveness
• Categorising patients based on an accurate IBS subtype is suggested to improve patient therapy
• A limited trial of a low FODMAP diet is recommended in patients with IBS to improve global IBS symptoms

Treatment

Soluble, but not insoluble, fibre should be used to treat global IBS symptoms. The use of peppermint to relieve global IBS symptoms is suggested. The use of antispasmodics for the treatment of global IBS symptoms is not recommended. Probiotics for the treatment of global IBS symptoms are not suggested. PEG products to relieve global IBS symptoms in those with IBS-C are not suggested.

1. The use of chloride channel activators to treat global IBS-C symptoms is recommended
2. Use of guanylate cyclase activators to treat global IBS-C symptoms is recommended
3. 5-HT4 agonist tegaserod is suggested to treat IBS-C symptoms in women younger than 65 years with cardiovascular risk factors who have not adequately responded to secretagogues
4. The use of bile acid sequestrants to treat global IBS-D symptoms is not suggested
5. Use of rifaximin to treat global IBS-D symptoms is recommended
6. Alosetron is recommended to relieve global IBS-D symptoms in women with severe symptoms who have failed conventional therapy.
7. Mixed opioid agonists/antagonists are suggested to treat global IBS-D symptoms.
8. Tricyclic antidepressants are recommended to treat global symptoms of IBS.
9. Gut-directed psychotherapies are suggested to be used to treat global IBS symptoms.
10. Use of foecal transplant for the treatment of global IBS symptoms is not recommended on the basis of available evidence.