IBS Management Guidelines 2009

What Your Doctor Knows About Treating IBS

Doctor talking to patient in hospital room
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Every few years, the American College of Gastroenterology (ACG) publishes a position statement regarding recommendations for IBS management, based on a review and analysis of available clinical research. Although the current guidelines cover much of the same tried and true ground, there are a few things that might surprise you. Knowing what is “state of the art” in terms of IBS management will help you take a more active role in your treatment partnership with your doctor.

What’s New and Surprising?


The following recommendations add a new spin to the traditional IBS diagnostic process:

  • Rectal bleeding and nighttime IBS symptoms used to be thought to be “red flag symptoms”, indicating something other than IBS. But according to the ACG, you no longer have to worry that your doctor has missed something more serious if you have these symptoms.
  • The ACG now recommends that all IBS patients be screened for celiac disease and lactose intolerance due to being at higher risk for having these conditions.
  • Colonoscopies are only recommended if you are over the age of 50 or have a family history of colorectal cancer. What’s new is that if a colonoscopy is performed, it is recommended that a biopsy of mucous tissue be performed to assess the presence of microscopic colitis, too.​​
  • IBS has been found to be a common symptom of Gulf War Syndrome, a multi-symptom illness suffered by soldiers who were involved in the 1991 Gulf War.

    Treatment of Abdominal Pain


      Antibiotics are a relatively new tool in your doctor’s proverbial black bag. Two antibiotics in particular, rifaximin and neomycin, have solid research backing their helpful effect on reducing diarrhea, bloating, and other IBS symptoms in IBS-D patients. These antibiotics are not absorbed in the stomach and thus may have an effect on bacteria located within the small and/or large intestine.

      What Else Do You Need to Know?

      Diet: In spite of the fact that many IBS patients often believe that there is a direct link between the food they have eaten and their symptoms, the ACG states that there is currently no good research to support a link between food allergies and IBS. The panel even goes so far as to say that exclusion diets only be used within the context of a research trial.

      ProbioticsProbiotics, so-called “friendly bacteria”, get a blessing from the ACG in spite of a lack of clear-cut research conclusions. The panel gave this thumbs-up due to the potential beneficial benefit of probiotics and the lack of any evidence of negative side effects.

      Psychotherapy: Many IBS patients don’t know that they can benefit from psychotherapy. According to the ACG, the following types of therapy have good research support in terms of reducing IBS suffering:


      American College of Gastroenterology IBS Task Force "An Evidence-Based Position Statement on the Management of Irritable Bowel Syndrome" American Journal of Gastroenterology 2009:S1-S35.

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