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Italian guidelines for the management of irritable bowel syndrome: Joint Consensus from the Italian Societies of: Gastroenterology and Endoscopy (SIGE), Neurogastroenterology and Motility (SINGEM), Hospital Gastroenterologists and Endoscopists (AIGO), Digestive Endoscopy (SIED), General Medicine (SIMG), Gastroenterology, Hepatology and Pediatric Nutrition (SIGENP) and Pediatrics (SIP)

Barbara, Giovanni; Cremon, Cesare; Bellini, Massimo; Corsetti, Maura; Di Nardo, Giovanni; Falangone, Francesca; Fuccio, Lorenzo; Galeazzi, Francesca; Iovino, Paola; Sarnelli, Giovanni; Savarino, Edoardo Vincenzo; Stanghellini, Vincenzo; Staiano, Annamaria; Stasi, Cristina; Tosetti, Cesare; Turco, Rossella; Ubaldi, Enzo; Zagari, Rocco Maurizio; Zenzeri, Letizia; Marasco, Giovanni

Italian guidelines for the management of irritable bowel syndrome: Joint Consensus from the Italian Societies of: Gastroenterology and Endoscopy (SIGE), Neurogastroenterology and Motility (SINGEM), Hospital Gastroenterologists and Endoscopists (AIGO), Digestive Endoscopy (SIED), General Medicine (SIMG), Gastroenterology, Hepatology and Pediatric Nutrition (SIGENP) and Pediatrics (SIP) Thumbnail


Authors

Giovanni Barbara

Cesare Cremon

Massimo Bellini

MAURA CORSETTI Maura.Corsetti@nottingham.ac.uk
Clinical Associate Professor

Giovanni Di Nardo

Francesca Falangone

Lorenzo Fuccio

Francesca Galeazzi

Paola Iovino

Giovanni Sarnelli

Edoardo Vincenzo Savarino

Vincenzo Stanghellini

Annamaria Staiano

Cristina Stasi

Cesare Tosetti

Rossella Turco

Enzo Ubaldi

Rocco Maurizio Zagari

Letizia Zenzeri

Giovanni Marasco



Abstract

The irritable bowel syndrome (IBS) is a chronic disorder of gut-brain interaction. IBS is still associated with areas of uncertainties, especially regarding the optimal diagnostic work-up and the more appropriate management. Experts from 7 Italian Societies conducted a Delphi consensus with literature summary and voting process on 27 statements. Recommendations and quality of evidence were evaluated using the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus was defined as >80% agreement and reached for all statements.

In terms of diagnosis, the consensus supports a positive diagnostic strategy with a symptom-based approach, including the psychological comorbidities assessment and the exclusion of alarm symptoms, together with the digital rectal examination, full blood count, C-reactive protein, serology for coeliac disease, and fecal calprotectin assessment. Colonoscopy should be recommended in patients with alarm features. Regarding treatment, the consensus strongly supports a dietary approach for patients with IBS, the use of soluble fiber, secretagogues, tricyclic antidepressants, psychologically directed therapies and, only in specific IBS subtypes, rifaximin. A conditional recommendation was achieved for probiotics, polyethylene glycol, antispasmodics, selective serotonin reuptake inhibitors and, only in specific IBS subtypes, 5-HT3 antagonists, 5-HT4 agonists, bile acid sequestrants.

Citation

Barbara, G., Cremon, C., Bellini, M., Corsetti, M., Di Nardo, G., Falangone, F., …Marasco, G. (2023). Italian guidelines for the management of irritable bowel syndrome: Joint Consensus from the Italian Societies of: Gastroenterology and Endoscopy (SIGE), Neurogastroenterology and Motility (SINGEM), Hospital Gastroenterologists and Endoscopists (AIGO), Digestive Endoscopy (SIED), General Medicine (SIMG), Gastroenterology, Hepatology and Pediatric Nutrition (SIGENP) and Pediatrics (SIP). Digestive and Liver Disease, 55(2), 187-207. https://doi.org/10.1016/j.dld.2022.11.015

Journal Article Type Article
Acceptance Date Nov 24, 2022
Online Publication Date Dec 11, 2022
Publication Date 2023-02
Deposit Date Feb 13, 2023
Publicly Available Date Dec 12, 2023
Electronic ISSN 1878-3562
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 55
Issue 2
Pages 187-207
DOI https://doi.org/10.1016/j.dld.2022.11.015
Keywords Gastroenterology; Hepatology
Public URL https://nottingham-repository.worktribe.com/output/15155956
Publisher URL https://www.sciencedirect.com/science/article/pii/S1590865822008143
Additional Information This article is maintained by: Elsevier; Article Title: Italian guidelines for the management of irritable bowel syndrome; Journal Title: Digestive and Liver Disease.

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