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

Gastroenterology. 2022 Jul;163(1):137-151. doi: 10.1053/j.gastro.2022.04.017.


Background & aims: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder 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 with predominant diarrhea (IBS-D) 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: eluxadoline, rifaximin, alosetron, loperamide, 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 8 recommendations for the management of patients with IBS-D. The panel made conditional recommendations for eluxadoline, rifaximin, alosetron, (moderate certainty), loperamide (very low certainty), tricyclic antidepressants, and anstispasmodics (low certainty). The panel made a conditional recommendation against the use of selective serotonin reuptake inhibitors (low certainty).

Keywords: Alosetron; Antidiarrheals; Antispasmodics; Eluxadoline; Irritable Bowel Syndrome; Meta-Analysis; Quality of Life; Randomized Controlled Trials; Rifaximin; Selective Serotonin Reuptake Inhibitors; Symptoms; Treatment; Tricyclic Antidepressants.

Publication types

  • Practice Guideline
  • Research Support, N.I.H., Extramural

MeSH terms

  • Antidepressive Agents, Tricyclic / therapeutic use
  • Diarrhea / diagnosis
  • Diarrhea / drug therapy
  • Diarrhea / etiology
  • Gastrointestinal Agents / therapeutic use
  • Humans
  • Irritable Bowel Syndrome* / complications
  • Irritable Bowel Syndrome* / diagnosis
  • Irritable Bowel Syndrome* / drug therapy
  • Loperamide / adverse effects
  • Rifaximin / therapeutic use
  • Selective Serotonin Reuptake Inhibitors / therapeutic use


  • Antidepressive Agents, Tricyclic
  • Gastrointestinal Agents
  • Serotonin Uptake Inhibitors
  • Loperamide
  • Rifaximin