The American Gastroenterological Association’s 2014 guideline on pharmacologic management of irritable bowel syndrome.
Irritable bowel syndrome is complex and encompasses several subgroups, including patients with constipation-predominant symptoms and those with diarrhea-predominant symptoms. The recommendations in this guideline apply to patients who meet the diagnostic criteria for IBS. Use of nonpharmaceutical agents (eg, fiber) and other interventions (eg, dietary modification, biofeedback, acupuncture) for treatment of patients with IBS was not covered. For constipation-predominant IBS, linactolide is strongly recommended (high-quality evidence); lubiprostone is conditionally recommended (moderate-quality evidence); and polyethylene glycol (PEG) laxatives are conditionally recommended (low-quality evidence). For diarrhea-predominant IBS, rifaximin and alosteron are conditionally recommended (moderate-quality evidence) and loperamide is conditionally recommended (very low-quality evidence). For IBS in general, tricyclic antidepressants and antispasmodics are conditionally recommended (low-quality evidence). The guideline recommends against use of selective serotonin reuptake inhibitors (SSRIs) for management of IBS (low-quality evidence).