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

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.