AGA Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome With Constipation

Lin Chang; Shahnaz Sultan; Anthony Lembo; G. Nicholas Verne; Walter Smalley; Joel J. Heidelbaugh

doi:10.1053/j.gastro.2022.04.016

AGA Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome With Constipation

Lin Chang, Shahnaz Sultan, Anthony Lembo, G. Nicholas Verne, Walter Smalley, Joel J. Heidelbaugh

Medicine - Gastro, Hepatology, Nutrition Division

Research output: Contribution to journal › Article › peer-review

48 Scopus citations

Abstract

Background & Aims: Irritable bowel syndrome (IBS) is a common disorder of gut–brain interaction associated with significant disease burden. This American Gastroenterological Association guideline is intended to support practitioners in decisions about the use of medications for the pharmacological management of IBS-C and is an update of a prior technical review and guideline. Methods: The Grading of Recommendations Assessment, Development and Evaluation framework was used to assess evidence and make recommendations. The technical review panel prioritized clinical questions and outcomes according to their importance for clinicians and patients and conducted an evidence review of the following agents: tenapanor, plecanatide, linaclotide, tegaserod, lubiprostone, polyethylene glycol laxatives, tricyclic antidepressants, selective serotonin reuptake inhibitors, and antispasmodics. The Guideline Panel reviewed the evidence and used the Evidence-to-Decision Framework to develop recommendations. Conclusions: The panel agreed on 9 recommendations for the management of patients with IBS-C. The panel made a strong recommendation for linaclotide (high certainty) and conditional recommendations for tenapanor, plecanatide, tegaserod, and lubiprostone (moderate certainty), polyethylene glycol laxatives, tricyclic antidepressants, and antispasmodics (low certainty). The panel made a conditional recommendation against the use of selective serotonin reuptake inhibitors (low certainty).

Original language	English (US)
Pages (from-to)	118-136
Number of pages	19
Journal	Gastroenterology
Volume	163
Issue number	1
DOIs	https://doi.org/10.1053/j.gastro.2022.04.016
State	Published - Jul 2022

Bibliographical note

Funding Information:
This document represents the official recommendations of the AGA and was developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. and adheres to best practices in guideline development, as outlined by the National Academy of Medicine (formerly Institute of Medicine) previously. Development of this guideline was fully funded by the AGA Institute. 18

Funding Information:
Conflicts of interest These authors disclose the following: Lin Chang has served as a member of the scientific advisory boards for Ardelyx, Immunic, Ironwood Mauna Kea Technologies, and Protagonist. She has served as a consultant for Trellus and a speaker for Abbvie. She has received research support from the National Institute of Health , Arena, AnX Robotica, and Ironwood. She has stock options with ModifyHealth and Trellus. Anthony Lembo has served as a member of the scientific advisory board for Arena, Ardelyx, Bioamerica, IM HealthSciences, Mauno Kea Technologies, Ironwood, Mylan, Orpho-Med, Ritter, Shire, Takeda, Vibrant and Allergan. He has received research support for clinical trials from National Institute of Health, Arena, Takeda, Vanda, and Vibrant, and Vanda. The remaining authors disclose no conflicts.

Funding Information:
Conflicts of interest These authors disclose the following: Lin Chang has served as a member of the scientific advisory boards for Ardelyx, Immunic, Ironwood Mauna Kea Technologies, and Protagonist. She has served as a consultant for Trellus and a speaker for Abbvie. She has received research support from the National Institute of Health, Arena, AnX Robotica, and Ironwood. She has stock options with ModifyHealth and Trellus. Anthony Lembo has served as a member of the scientific advisory board for Arena, Ardelyx, Bioamerica, IM HealthSciences, Mauno Kea Technologies, Ironwood, Mylan, Orpho-Med, Ritter, Shire, Takeda, Vibrant and Allergan. He has received research support for clinical trials from National Institute of Health, Arena, Takeda, Vanda, and Vibrant, and Vanda. The remaining authors disclose no conflicts.Funding G. Nicholas Verne is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (DK099052 and DK118959). Shahnaz Sultan is supported by the National Heart, Lung, and Blood Institute at the National Institute of Health for Asthma Guideline Development.

Funding Information:
Funding G. Nicholas Verne is supported by the National Institute of Diabetes and Digestive and Kidney Diseases ( DK099052 and DK118959 ). Shahnaz Sultan is supported by the National Heart, Lung, and Blood Institute at the National Institute of Health for Asthma Guideline Development.

Publisher Copyright:
© 2022

Keywords

Antispasmodic
Irritable Bowel Syndrome
Linaclotide
Lubiprostone
Meta-Analysis
Plecanatide
Polyethylene Glycol
Quality of Life
Randomized Controlled Trial
Selective Serotonin Reuptake Inhibitor
Symptoms
Tegaserod
Tenapanor
Treatment
Tricyclic Antidepressant

PubMed: MeSH publication types

Practice Guideline
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural
Journal Article

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10.1053/j.gastro.2022.04.016

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title = "AGA Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome With Constipation",

abstract = "Background & Aims: Irritable bowel syndrome (IBS) is a common disorder of gut–brain interaction associated with significant disease burden. This American Gastroenterological Association guideline is intended to support practitioners in decisions about the use of medications for the pharmacological management of IBS-C and is an update of a prior technical review and guideline. Methods: The Grading of Recommendations Assessment, Development and Evaluation framework was used to assess evidence and make recommendations. The technical review panel prioritized clinical questions and outcomes according to their importance for clinicians and patients and conducted an evidence review of the following agents: tenapanor, plecanatide, linaclotide, tegaserod, lubiprostone, polyethylene glycol laxatives, tricyclic antidepressants, selective serotonin reuptake inhibitors, and antispasmodics. The Guideline Panel reviewed the evidence and used the Evidence-to-Decision Framework to develop recommendations. Conclusions: The panel agreed on 9 recommendations for the management of patients with IBS-C. The panel made a strong recommendation for linaclotide (high certainty) and conditional recommendations for tenapanor, plecanatide, tegaserod, and lubiprostone (moderate certainty), polyethylene glycol laxatives, tricyclic antidepressants, and antispasmodics (low certainty). The panel made a conditional recommendation against the use of selective serotonin reuptake inhibitors (low certainty).",

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author = "Lin Chang and Shahnaz Sultan and Anthony Lembo and Verne, {G. Nicholas} and Walter Smalley and Heidelbaugh, {Joel J.}",

note = "Funding Information: This document represents the official recommendations of the AGA and was developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. and adheres to best practices in guideline development, as outlined by the National Academy of Medicine (formerly Institute of Medicine) previously. Development of this guideline was fully funded by the AGA Institute. 18 Funding Information: Conflicts of interest These authors disclose the following: Lin Chang has served as a member of the scientific advisory boards for Ardelyx, Immunic, Ironwood Mauna Kea Technologies, and Protagonist. She has served as a consultant for Trellus and a speaker for Abbvie. She has received research support from the National Institute of Health , Arena, AnX Robotica, and Ironwood. She has stock options with ModifyHealth and Trellus. Anthony Lembo has served as a member of the scientific advisory board for Arena, Ardelyx, Bioamerica, IM HealthSciences, Mauno Kea Technologies, Ironwood, Mylan, Orpho-Med, Ritter, Shire, Takeda, Vibrant and Allergan. He has received research support for clinical trials from National Institute of Health, Arena, Takeda, Vanda, and Vibrant, and Vanda. The remaining authors disclose no conflicts. Funding Information: Conflicts of interest These authors disclose the following: Lin Chang has served as a member of the scientific advisory boards for Ardelyx, Immunic, Ironwood Mauna Kea Technologies, and Protagonist. She has served as a consultant for Trellus and a speaker for Abbvie. She has received research support from the National Institute of Health, Arena, AnX Robotica, and Ironwood. She has stock options with ModifyHealth and Trellus. Anthony Lembo has served as a member of the scientific advisory board for Arena, Ardelyx, Bioamerica, IM HealthSciences, Mauno Kea Technologies, Ironwood, Mylan, Orpho-Med, Ritter, Shire, Takeda, Vibrant and Allergan. He has received research support for clinical trials from National Institute of Health, Arena, Takeda, Vanda, and Vibrant, and Vanda. The remaining authors disclose no conflicts.Funding G. Nicholas Verne is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (DK099052 and DK118959). Shahnaz Sultan is supported by the National Heart, Lung, and Blood Institute at the National Institute of Health for Asthma Guideline Development. Funding Information: Funding G. Nicholas Verne is supported by the National Institute of Diabetes and Digestive and Kidney Diseases ( DK099052 and DK118959 ). Shahnaz Sultan is supported by the National Heart, Lung, and Blood Institute at the National Institute of Health for Asthma Guideline Development. Publisher Copyright: {\textcopyright} 2022",

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AGA Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome With Constipation

Abstract

Bibliographical note

Keywords

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