In a new American College of Gastroenterology clinical guideline, published in The American Journal of Gastroenterology, recommendations are presented for diagnostic testing and therapeutic options for patients with irritable bowel syndrome (IBS). After a comprehensive literature search, 25 clinically important questions were assessed for the first of its kind guideline; nine focused on diagnostic testing and 16 focused on therapeutic options. The authors suggest use of a positive diagnostic strategy rather than a diagnostic strategy of exclusion for improving time to initiating appropriate therapy. To rule out celiac disease in patients with IBS and diarrhea symptoms, serologic testing is suggested. To rule out inflammatory bowel disease, it is suggested that fecal calprotectin be checked in patients with suspected IBS and diarrhea. A limited trial of a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet is recommended for improving global symptoms in patients with IBS. To treat global IBS with constipation symptoms, use of chloride channel activators and guanylate cyclase activators is recommended. To treat global IBS with diarrhea symptoms, use of rifaximin is recommended. Gut-directed psychotherapy is suggested for treating global IBS symptoms.
