Drug options for IBS 'should be easier to navigate with new guideline'

Date: Nov-11-2014 The American Gastroenterological Association have

published a new guideline on drugs for irritable bowel syndrome. The

aim of the document is to make it easier for patients and their

doctors to select the right drugs for the right symptoms.

The AGA say their new guideline offers an evidence-based approach to help IBS patients and their doctors navigate the wealth of drug

information.

Irritable bowel syndrome (IBS) is a disorder in how the

gastrointestinal (GI) tract works; it is a cluster of symptoms

rather than a disease. While IBS symptoms can occur frequently, they do

not damage the GI tract.

The cause of IBS is unknown. Symptoms can include cramp, gassiness,

bloating, changes in bowel habits, constipation and diarrhea. At times,

IBS can make patients feel a need to move the bowels, but then they

find they are unable to.

IBS does not lead to more serious diseases, such as cancer or

inflammatory bowel disease. For most people, the symptoms are mild and

annoying, but there are cases where they can be disabling.

According to the American Gastroenterological Association (AGA), IBS

affects up to 15% of the general adult population, and most patients

struggle to achieve the correct drug therapy for their particular

symptoms.

The AGA say their new guideline - published in the journal

Gastroenterology - offers an evidence-based approach to help

these patients and their doctors navigate the wealth of drug

information.

Dr. Shahnaz Sultan - an assistant professor of medicine at the

University of Florida College of Medicine and the Department of Veteran Affairs

Medical Center of the North Florida/South Georgia Veterans Health

System - comments on the new guideline that she co-authored:

"Because no IBS therapy is uniformly effective, many patients

describe a history of a variety of treatments alone or in combination.

This guideline will help patients and physicians navigate the drug

options. It's also important to consider other clinically relevant

information, such as a patient's values and preferences, when making

treatment decisions."

In compiling the new guideline, Dr. Sultan and colleagues followed

the Institute of Medicine's Grading of Recommendations Assessment,

Development and Evaluation (GRADE) methodology. This helped them sift

through the large number of published IBS studies and pick out the ones

in which the quality of data and balance between risks and benefits clearly

supported the use of the particular drugs they examined.

Two classes of recommendation: strong and conditional

Using the GRADE system, the authors put the recommendations into two

classes: strong recommendations and conditional (or weak)

recommendations. These have different implications for patients,

clinicians and policy makers, as follows:

Strong recommendations are those where patients

would most likely not need formal help to decide whether the

recommended course of action fits in with their values and preferences.

Most patients would want the recommended course of action and only a

small minority would not.

For clinicians, the implication of a strong recommendation is that

most patients should receive the recommended treatment, and following

the recommendation in line with the guidance could be used as a

standard for assessing quality or performance. Most patients would be

unlikely to need help in deciding whether the recommendation fits their

values and preferences.

For policymakers, a strong recommendation means the recommendation

can form the basis of policy in most situations.

Conditional (or weak) recommendations are those

where most people would want the recommended course of action but many

would not. Patients would most likely need formal decision aids to help

them decide whether the recommended treatment is consistent with their

values and preferences.

For clinicians, the implication of a conditional recommendation is

that they will likely need to examine the evidence to help patients make up

their minds as to whether the recommended course of action fits in with

their values or preferences.

For policymakers, a conditional recommendation is one that requires

considerable debate with stakeholders in order to formulate policy.

New recommendations by IBS type

For IBS with constipation (IBS-C)

For patients with IBS-C (constipation), the AGA guideline recommends

linaclotide over no drug treatment, and it grades it as a strong

recommendation supported by high-quality evidence.

The AGA suggest using lubiprostone over no drug treatment in

patients with IBS-C, but they class this as a conditional recommendation

based on moderate-quality evidence.

The AGA suggest using laxatives over no drug treatment in patients

with IBS-C, but they class this as a conditional recommendation based on

low-quality evidence.

For IBS with diarrhea (IBS-D)

For patients with IBS-D (diarrhea), the AGA guideline has no strong

recommendations.

The guideline suggests using rifaximin over no drug treatment in

patients with IBS-D, and it classes this as a conditional recommendation

supported by moderate-quality evidence.

To improve global symptoms in patients with IBS-D, the guideline

suggests using alosetron over no drug treatment and classes this as a

conditional recommendation supported by moderate-quality evidence.

The guideline also suggests using loperamide over no drug treatment

in patients with IBS-D, but it classes this as a conditional

recommendation supported by very low-quality evidence.

The use of antidepressants and antispasmodics for IBS

The AGA guideline suggests using tricyclic antidepressants over no

drug treatment in patients with IBS and classes this recommendation as

conditional, supported by low-quality evidence.

The guideline recommends against using selective serotonin reuptake

inhibitors for patients with IBS, and it classes this as a conditional

recommendation supported by low-quality evidence.

The guideline suggests using antispasmodics (over no drug treatment)

in patients with IBS, and classes this as a conditional recommendation supported by low-quality evidence.

The authors note that in most cases, in the wealth of literature

they surveyed, they found the quality of the data and the balance of

risks and benefits for a particular therapy did not overwhelmingly

support the use of particular drugs.

They found no studies that compared the effectiveness of commonly

used drugs, and neither did they find any studies that compared combinations of

commonly used drugs.

Within the stated limitations, the AGA believe the new guideline

represents a rigorous, evidence-based summary of the extensive

literature on the use of drugs to treat IBS.

In March, Medical News Today learned of another report

in the journal Gastroenterology, where an international team

of researchers suggested there may be a

genetic basis for some cases of IBS.

Written by Catharine Paddock PhD

Not to be reproduced without permission.

Follow @twitter

window.twttr = (function (d, s, id) {
var t, js, fjs = d.getElementsByTagName(s)[0];
if (d.getElementById(id)) return;
js = d.createElement(s); js.id = id;
js.src= "https://platform.twitter.com/widgets.js";
fjs.parentNode.insertBefore(js, fjs);
return window.twttr || (t = { _e: [], ready: function (f) { t._e.push(f) }
}(document, "script", "twitter-wjs"));

Courtesy: Medical News Today Note: Any medical information available in this news section is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.