Welcome!

News Feed Item

American College of Gastroenterology Releases Evidence-Based Systematic Review on Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation

New Graded Information on Diet, Probiotics, Antibiotics, Antidepressants for IBS

BETHESDA, Md., Aug. 5, 2014 /PRNewswire-USNewswire/ -- Today, the American College of Gastroenterology (ACG) published a new systematic review of evidence about the management of irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC) to update earlier reviews from 2009 and 2005 as a supplement to the August 2014 issue of The American Journal of Gastroenterology.  This analysis will allow physicians to better care for patients with IBS and CIC, and features new information for clinicians to consider when making recommendations about diet, probiotics, antibiotics and antidepressants for IBS, as well as the use of fiber, laxatives, and recently developed drugs—prucalopride, lubiprostone and linaclotide for managing constipation. This review also summarizes information about the effectiveness of other therapies, such as alosetron, lubiprostone and linaclotide, in treatment of IBS.

American College of Gastroenterology

View the full ACG Evidence-Based Systematic Review on IBS and CIC.

IBS and CIC (also referred to as functional constipation) are two of the most common functional gastrointestinal disorders worldwide, impacting anywhere from 5 to 15 percent of the global population. These conditions affect more than 30 million Americans and are among the most common gastrointestinal disorders treated by physicians. Although there has been an increase in the number of scientific studies of these conditions, they vary in quality, making it difficult for physicians to sort out the best approaches for management. 

In general, treatments for IBS are directed towards the patient's predominant symptoms. With a wide variety of available therapies, many of which improve individual IBS symptoms, only a small number of therapies have been shown to be of benefit for global symptoms of IBS.  

"In order to evaluate the rapidly expanding research about IBS and CIC and to assess the evidence of efficacy of new IBS and constipation drugs, ACG sponsored an independent, systematic review, and all available studies were reviewed by the ACG Functional Bowel Disorders Task Force after a careful and systematic search of the literature in order to update the recommendations," explained Eamonn M.M. Quigley, MD, FACG, who chaired the expert task force.  "Studies meeting pre-specified criteria that were selected to minimize bias were examined in detail and summarized. When possible, results were combined by a formal meta-analysis to improve the reliability of conclusions."

The quality of the evidence was graded by standard criteria and recommendations were developed based on the quality of the evidence and additional factors such as risk, cost and acceptability to patients.

The College's new recommendations include updated information and expert assessments of traditional therapies for IBS and CIC, as well as a range of new treatment approaches, including evidence on diet, probiotics; the non-absorbable antibiotic rifaximin; antidepressants; antispasmodics and peppermint oil; fiber, bulking agents and laxatives; antidiarrheals, including loperamide; the 5-HT3 receptor antagonist alosetron; the 5-HT4 (serotonin) receptor agonist tegaserod; the chloride channel activator lubiprostone; psychological therapies such as hypnotherapy and biofeedback; herbal preparations; and acupuncture.

Highlights of ACG's New Recommendations on IBS Therapies

  • Special elimination diets may be effective, but existing evidence is weak.
  • Fiber may be helpful in relieving IBS symptoms; there is better evidence in support of an effect of psyllium than of bran for IBS.
  • Prebiotics and synbiotics have insufficient evidence of effect in IBS.
  • Probiotics improve global symptoms, bloating and flatulence in IBS.
  • Rifaxamin, a poorly absorbed antibiotic, has moderate evidence in support of effectiveness in IBS with diarrhea.
  • Linaclotide and lubiprostone have strong recommendations for IBS with constipation.
  • There is better evidence than in the past to support the use of antidepressants and psychological therapies in IBS.

Highlights of ACG's New Recommendations on CIC Therapies

  • Fiber supplements are given a strong recommendation for use in CIC.
  • Laxatives—including polyethylene glycol (PEG), lactulose, sodium picosulfate and bisacodyl—have strong recommendations for the treatment of CIC.
  • Prucalopride, lubiprostone and linaclotide have been given strong recommendations for treatment of CIC.

"This new meta-analysis of the literature on the management of IBS and chronic idiopathic constipation offers physicians scientifically-based guidance to make clinical decisions about these conditions based on a thorough assessment of the evidence," said Lawrence R. Schiller, MD, FACG, who is also a member of the ACG Functional Bowel Disorders Task Force.  "However, it is important that patients talk with their doctors about their treatment options, as there is no one-size-fits-all approach to managing IBS or chronic constipation. It's also vital that patients not be embarrassed to talk openly about their symptoms with their doctor in order to collaboratively determine the best treatment plan for their individual situation."

About IBS
For the clinical gastroenterologist, IBS is one of the most commonly seen digestive problems.  IBS is characterized by abdominal discomfort associated with altered bowel function; structural and biochemical abnormalities are absent. The pathophysiology of IBS is multi-factorial.  Individual symptoms have limited accuracy for diagnosing IBS, and the disorder is considered as a symptom complex. 

About CIC
Constipation is a symptom-based disorder defined as unsatisfactory defecation, and is characterized by infrequent stools, difficult stool passage or both. Difficult stool passage includes straining, a sense of difficulty passing stool, incomplete evacuation, hard/lumpy stools, prolonged time to pass stool, or need for manual maneuvers to pass stool. CIC is defined as the presence of these symptoms for at least 3 months.

ACG Expert Task Force on the Management of Functional Bowel Disorders 

  • Chair, Eamonn M.M. Quigley, MD, FRCP, FACG, Houston, Methodist Hospital and Weill   Cornell Medical College
  • Brian E. Lacy, MD, PhD, FACG, Dartmouth-Hitchcock Medical Center
  • Anthony J. Lembo, MD, Harvard Medical School, Beth Israel Deaconess Medical Center
  • Paul Moayyedi, BSc, MB, ChB, PhD, MPH, FRCP (London), FRCPC, FACG*, McMaster University Medical Centre
  • Yuri Saito, MD, MPH, Mayo Clinic, Rochester
  • Lawrence R. Schiller, MD, FACG, Baylor University Medical Center
  • Edy E. Soffer, MD, FACG, Keck School of Medicine, University of Southern California
  • Brennan M. R. Spiegel, MD, MSHS, UCLA School of Medicine

*Dr. Moayyedi conducted the systematic reviews with support from Alexander C. Ford, MD, ChB, MD, FRCP, and carried out the technical analyses of the data independent of the Task Force.

About the American College of Gastroenterology
Founded in 1932, the American College of Gastroenterology (ACG) is an organization with an international membership of more than 12,000 individuals from 80 countries. The College's vision is to be the pre-eminent professional organization that champions the evolving needs of clinicians in the delivery of high quality, evidence-based, and compassionate health care to gastroenterology patients. The mission of the College is to advance world-class care for patients with gastrointestinal disorders through excellence, innovation and advocacy in the areas of scientific investigation, education, prevention and treatment. www.gi.org

About The American Journal of Gastroenterology
The American Journal of Gastroenterology is published on behalf of the American College of Gastroenterology by Nature Publishing Group. As the leading clinical journal covering gastroenterology and hepatology, The American Journal of Gastroenterology provides practical and professional support for clinicians dealing with the gastroenterological disorders seen most often in patients. Published with practicing clinicians in mind, AJG devotes itself to publishing timely medical research in gastroenterology and hepatology. The Co-Editors-in-Chief are William D. Chey, MD, AGAF, FACG, FACP of the University of Michigan and Paul Moayyedi, BSc, MB ChB, PhD, MPH, FRCP, FRCPC, FACG of McMaster University.

Logo - http://photos.prnewswire.com/prnh/20140421/76919

 

SOURCE American College of Gastroenterology

More Stories By PR Newswire

Copyright © 2007 PR Newswire. All rights reserved. Republication or redistribution of PRNewswire content is expressly prohibited without the prior written consent of PRNewswire. PRNewswire shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon.

Latest Stories
Developing software for the Internet of Things (IoT) comes with its own set of challenges. Security, privacy, and unified standards are a few key issues. In addition, each IoT product is comprised of (at least) three separate application components: the software embedded in the device, the back-end service, and the mobile application for the end user’s controls. Each component is developed by a different team, using different technologies and practices, and deployed to a different stack/target –...
SYS-CON Events announced today Telecom Reseller has been named “Media Sponsor” of SYS-CON's 19th International Cloud Expo, which will take place on November 1–3, 2016, at the Santa Clara Convention Center in Santa Clara, CA. Telecom Reseller reports on Unified Communications, UCaaS, BPaaS for enterprise and SMBs. They report extensively on both customer premises based solutions such as IP-PBX as well as cloud based and hosted platforms.
Traditional on-premises data centers have long been the domain of modern data platforms like Apache Hadoop, meaning companies who build their business on public cloud were challenged to run Big Data processing and analytics at scale. But recent advancements in Hadoop performance, security, and most importantly cloud-native integrations, are giving organizations the ability to truly gain value from all their data. In his session at 19th Cloud Expo, David Tishgart, Director of Product Marketing ...
Almost two-thirds of companies either have or soon will have IoT as the backbone of their business in 2016. However, IoT is far more complex than most firms expected. How can you not get trapped in the pitfalls? In his session at @ThingsExpo, Tony Shan, a renowned visionary and thought leader, will introduce a holistic method of IoTification, which is the process of IoTifying the existing technology and business models to adopt and leverage IoT. He will drill down to the components in this fra...
Fact: storage performance problems have only gotten more complicated, as applications not only have become largely virtualized, but also have moved to cloud-based infrastructures. Storage performance in virtualized environments isn’t just about IOPS anymore. Instead, you need to guarantee performance for individual VMs, helping applications maintain performance as the number of VMs continues to go up in real time. In his session at Cloud Expo, Dhiraj Sehgal, Product and Marketing at Tintri, wil...
Pulzze Systems was happy to participate in such a premier event and thankful to be receiving the winning investment and global network support from G-Startup Worldwide. It is an exciting time for Pulzze to showcase the effectiveness of innovative technologies and enable them to make the world smarter and better. The reputable contest is held to identify promising startups around the globe that are assured to change the world through their innovative products and disruptive technologies. There w...
StarNet Communications Corp has announced the addition of three Secure Remote Desktop modules to its flagship X-Win32 PC X server. The new modules enable X-Win32 to safely tunnel the remote desktops from Linux and Unix servers to the user’s PC over encrypted SSH. Traditionally, users of PC X servers deploy the XDMCP protocol to display remote desktop environments such as the Gnome and KDE desktops on Linux servers and the CDE environment on Solaris Unix machines. XDMCP is used primarily on comp...
There is growing need for data-driven applications and the need for digital platforms to build these apps. In his session at 19th Cloud Expo, Muddu Sudhakar, VP and GM of Security & IoT at Splunk, will cover different PaaS solutions and Big Data platforms that are available to build applications. In addition, AI and machine learning are creating new requirements that developers need in the building of next-gen apps. The next-generation digital platforms have some of the past platform needs a...
SYS-CON Events announced today that StarNet Communications will exhibit at the 19th International Cloud Expo, which will take place on November 1–3, 2016, at the Santa Clara Convention Center in Santa Clara, CA. StarNet Communications’ FastX is the industry first cloud-based remote X Windows emulator. Using standard Web browsers (FireFox, Chrome, Safari, etc.) users from around the world gain highly secure access to applications and data hosted on Linux-based servers in a central data center. ...
Extreme Computing is the ability to leverage highly performant infrastructure and software to accelerate Big Data, machine learning, HPC, and Enterprise applications. High IOPS Storage, low-latency networks, in-memory databases, GPUs and other parallel accelerators are being used to achieve faster results and help businesses make better decisions. In his session at 18th Cloud Expo, Michael O'Neill, Strategic Business Development at NVIDIA, focused on some of the unique ways extreme computing is...
With so much going on in this space you could be forgiven for thinking you were always working with yesterday’s technologies. So much change, so quickly. What do you do if you have to build a solution from the ground up that is expected to live in the field for at least 5-10 years? This is the challenge we faced when we looked to refresh our existing 10-year-old custom hardware stack to measure the fullness of trash cans and compactors.
The emerging Internet of Everything creates tremendous new opportunities for customer engagement and business model innovation. However, enterprises must overcome a number of critical challenges to bring these new solutions to market. In his session at @ThingsExpo, Michael Martin, CTO/CIO at nfrastructure, outlined these key challenges and recommended approaches for overcoming them to achieve speed and agility in the design, development and implementation of Internet of Everything solutions wi...
Today we can collect lots and lots of performance data. We build beautiful dashboards and even have fancy query languages to access and transform the data. Still performance data is a secret language only a couple of people understand. The more business becomes digital the more stakeholders are interested in this data including how it relates to business. Some of these people have never used a monitoring tool before. They have a question on their mind like “How is my application doing” but no id...
Cloud computing is being adopted in one form or another by 94% of enterprises today. Tens of billions of new devices are being connected to The Internet of Things. And Big Data is driving this bus. An exponential increase is expected in the amount of information being processed, managed, analyzed, and acted upon by enterprise IT. This amazing is not part of some distant future - it is happening today. One report shows a 650% increase in enterprise data by 2020. Other estimates are even higher....
Smart Cities are here to stay, but for their promise to be delivered, the data they produce must not be put in new siloes. In his session at @ThingsExpo, Mathias Herberts, Co-founder and CTO of Cityzen Data, will deep dive into best practices that will ensure a successful smart city journey.