New UK guidelines on irritable bowel syndrome.
The British Society of Gastroenterology has issued comprehensive new guidelines on the management of irritable bowel syndrome (IBS). These cover the diagnosis and management of this common condition, affecting 5-11% of the population. Most sufferers will present to their GP, however a significant proportion - from around 33% up to 90% in some studies - will self-manage.
The guidelines cover the diagnosis of IBS, which is made easier by the availability of agreed diagnostic criteria (Rome-III criteria). They also detail alarm features that suggest the possibility of an alternative diagnosis requiring further investigation. Diagnosis should include looking for adverse psychological features, as these will affect response to treatment if present.
Management is multi-factorial and no single treatment benefits more than 20% of patients. Psychological therapies and correction of any concomitant anxiety or depression are valuable in many patients. Although many drug therapies have been tried, the evidence for most is limited; however there is some evidence of benefit in appropriate patients for antispasmodics, soluble fibre, 5-HT3 antagonists, 5-HT4 antagonists, SSRI, and tricyclic antidepressives. There is a great need for ways of identifying which patients will respond best to specific therapies. (437 references)
Gut, published early online 8 May 2007; doi:10.1136/gut.2007.119446 (link to abstract); the guidelines will become freely available from the British Society of Gastroenterology website here (not yet available at time of posting).