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Functional bowel disorders with diarrhoea: Clinical guidelines of the United European Gastroenterology and European Society for Neurogastroenterology and Motility


Edoardo Savarino

Fabiana Zingone

Brigida Barberio

Giovanni Marasco

Filiz Akyuz

Hale Akpinar

Oana Barboi

Giorgia Bodini

Serhat Bor

Giuseppe Chiarioni

Gheorghe Cristian

Antonio Di Sabatino

Anca Mirela Dimitriu

Vasile Drug

Dan L. Dumitrascu

Alexander C. Ford

Goran Hauser

Radislav Nakov

Nisha Patel

Daniel Pohl

C?t?lin Sfarti

Jordi Serra


Alina Suciu

Jan Tack

Murat Toruner

Julian Walters

Cesare Cremon

Giovanni Barbara


Irritable bowel syndrome with diarrhoea (IBS-D) and functional diarrhoea (FDr) are the two major functional bowel disorders characterized by diarrhoea. In spite of their high prevalence, IBS-D and FDr are associated with major uncertainties, especially regarding their optimal diagnostic work-up and management. A Delphi consensus was performed with experts from 10 European countries who conducted a literature summary and voting process on 31 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation criteria. Consensus (defined as >80% agreement) was reached for all the statements. The panel agreed with the potential overlapping of IBS-D and FDr. In terms of diagnosis, the consensus supports a symptom-based approach also with the exclusion of alarm symptoms, recommending the evaluation of full blood count, C-reactive protein, serology for coeliac disease, and faecal calprotectin, and consideration of diagnosing bile acid diarrhoea. Colonoscopy with random biopsies in both the right and left colon is recommended in patients older than 50years and in presence of alarm features. Regarding treatment, a strong consensus was achieved for the use of a diet low fermentable oligo-, di-, monosaccharides and polyols, gut-directed psychological therapies, rifaximin, loperamide, and eluxadoline. A weak or conditional recommendation was achieved for antispasmodics, probiotics, tryciclic antidepressants, bile acid sequestrants, 5-hydroxytryptamine-3 antagonists (i.e. alosetron, ondansetron, or ramosetron). A multinational group of European experts summarized the current state of consensus on the definition, diagnosis, and management of IBS-D and FDr.


Savarino, E., Zingone, F., Barberio, B., Marasco, G., Akyuz, F., Akpinar, H., …Barbara, G. (2022). Functional bowel disorders with diarrhoea: Clinical guidelines of the United European Gastroenterology and European Society for Neurogastroenterology and Motility. United European Gastroenterology Journal, 10(6), 556-584.

Journal Article Type Article
Acceptance Date May 20, 2022
Online Publication Date Jun 13, 2022
Publication Date Jul 1, 2022
Deposit Date Jul 12, 2022
Publicly Available Date Jul 14, 2022
Journal United European Gastroenterology Journal
Print ISSN 2050-6406
Electronic ISSN 2050-6414
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Volume 10
Issue 6
Pages 556-584
Keywords Gastroenterology; Oncology
Public URL
Publisher URL


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