gi.ibs.core.v1PRODUCTION

gi.ibs.core.v1

Irritable Bowel Syndrome (Rome IV; IBS-D / IBS-C / IBS-M / IBS-U; post-infectious IBS)

gastroenterologychronicadult

Hard-required inputs

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Care setting:

Encounter flow

12/12 authored

Canonical 12-phase frame with authored status for this dossier.

Current phase

Frame

Detailed

Apply Rome IV POSITIVE diagnosis — recurrent abdominal pain ≥1 day/week in the last 3 months, onset ≥6 months ago, with ≥2 of: related to defecation / change in stool frequency / change in stool form. Assign subtype by predominant Bristol Stool Form (IBS-D >25% type 6-7 & <25% type 1-2; IBS-C >25% type 1-2 & <25% type 6-7; IBS-M both >25%; IBS-U insufficient abnormal stools). NOT a diagnosis of exclusion (ACG 2021; Rome IV)

Inputs

Actions

Advance rule

Set

Advance when

Rome IV criteria met and subtype assigned

Patient inputs (17)

age*demographic • CONTEXT

Age ≥50 with new-onset symptoms is an alarm feature mandating colorectal workup; older age also lowers IBS pre-test probability and shifts toward organic disease (ACG 2021; BSG 2021)

sex*demographic • CONTEXT

Alosetron REMS restricts use to women with severe refractory IBS-D; female predominance informs pre-test probability (ACG 2021)

family_history_crc_ibd_coeliac*history • CONTEXT

not present

Family history of colorectal cancer, IBD, or coeliac disease is an alarm feature lowering the threshold for endoscopic / serologic workup (ACG 2021; BSG 2021)

recurrent_abdominal_pain*symptom • FRAME

Rome IV positive criterion — recurrent abdominal pain ≥1 day/week in last 3 months, onset ≥6 months ago, ≥2 of: related to defecation / change in stool frequency / change in stool form

altered_bowel_habit*symptom • FRAME

Bristol Stool Form Scale of predominant abnormal stools defines subtype (IBS-D / IBS-C / IBS-M / IBS-U) and is the central treatment-selection variable (Rome IV; ACG 2021)

symptom_duration*history • FRAME

not present

Rome IV requires onset ≥6 months ago and active criteria for the last 3 months — a strict temporal anchor of the positive diagnosis

cbc*lab • INITIAL_WORKUP

Iron-deficiency anaemia is an alarm feature; baseline before therapy; minimal-testing component of the Rome IV positive-diagnosis pathway

crp*lab • INITIAL_WORKUP

Inflammatory marker — elevation argues against IBS and toward IBD/organic disease; part of minimal testing (ACG 2021; BSG 2021)

coeliac_serology_ttg_iga*lab • INITIAL_WORKUP

Anti-tissue-transglutaminase IgA (with total IgA) — coeliac disease is enriched in IBS-D/M and must be excluded (ACG 2021 strong recommendation)

faecal_calprotectin*lab • INITIAL_WORKUP

In IBS-D/IBS-M, calprotectin distinguishes IBS from IBD (cut-off ≤50 µg/g: pooled sensitivity ~85.8%, specificity ~91.7%; high NPV in low-prevalence setting) (Bhattacharya 2023 PMID 37823411)

alarm_features*symptom • RED_FLAGS

Rectal bleeding/melaena, unintentional weight loss, nocturnal symptoms, progressive symptoms, palpable mass — each reroutes to an organic-disease workup and overrides a Rome IV positive diagnosis (ACG 2021; BSG 2021)

post_infectious_onsethistory • CONTEXT

not present

IBS following acute infectious enteritis (post-infectious IBS, usually IBS-D) carries a distinct natural history with gradual improvement over years (Klem 2017 PMID 28069350)

psych_comorbidityhistory • CONTEXT

not present

Anxiety/depression are bidirectionally linked to IBS via the gut-brain axis and modify therapy selection (neuromodulators, psychological therapy) (ACG 2021; BSG 2021)

pregnancy_statushistory • CONTEXT

Eluxadoline / alosetron / secretagogues require avoidance or caution in pregnancy; dietary and loperamide/PEG safety tiers apply (ACG 2021)

tshlab • INITIAL_WORKUP

Thyroid dysfunction mimics altered bowel habit (hyperthyroidism → diarrhoea; hypothyroidism → constipation); checked when bowel habit is atypical (chronic-diarrhoea first tier, AGA 2017)

cholecystectomy_alcohol_pancreatitishistory • TREATMENT

not present

Eluxadoline is contraindicated without a gallbladder, with sphincter-of-Oddi dysfunction, prior pancreatitis, or >3 alcoholic drinks/day (FDA pancreatitis safety signal) (ACG 2021)

creatininelab • TREATMENT

Renal dosing of secretagogues and rifaximin; baseline before TCA/SSRI in comorbid disease

* = hard-required. Engine cannot meaningfully run until these are filled.

Severity triggers (6)

6 need judgement

informationallife_threateningeluxadoline_pancreatitis_red_flag
Severe epigastric/RUQ pain ± vomiting in a patient on eluxadoline — sphincter-of-Oddi spasm / pancreatitis (FDA safety signal; AGA IBS-D 2022 PMID 35738725)
Trigger could not be auto-evaluated — needs clinician judgement.
informationalseverealarm_feature_present
Any alarm feature — age ≥50 new onset, rectal bleeding/melaena, unintentional weight loss, iron-deficiency anaemia, nocturnal or progressive symptoms, palpable mass, family history CRC/IBD/coeliac (ACG 2021; BSG 2021)
Trigger could not be auto-evaluated — needs clinician judgement.
informationalseveresevere_psych_comorbidity_or_suicidality
Severe depression/anxiety or positive PHQ-9 item 9 (suicidality) in an IBS patient (ACG 2021; bidirectional gut-brain axis)
Trigger could not be auto-evaluated — needs clinician judgement.
informationalseveresevere_ibs_d_dehydration_electrolyte
Severe IBS-D with high stool output causing dehydration / electrolyte disturbance (BSG 2021)
Trigger could not be auto-evaluated — needs clinician judgement.
informationalseverealosetron_ischaemic_colitis
New/worsening abdominal pain or rectal bleeding, or severe constipation, in a patient on alosetron (REMS) (ACG 2021)
Trigger could not be auto-evaluated — needs clinician judgement.
informationalmoderaterefractory_to_two_therapy_classes
Persistent IBS symptoms after adequate trials of ≥2 distinct therapy classes including a gut-brain neuromodulator (ACG 2021)
Trigger could not be auto-evaluated — needs clinician judgement.

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CONTEXToptionalDrives screening

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Recommended regimen

IBS subtype-directed therapy (ACG 2021 + AGA IBS-C/IBS-D 2022 + BSG 2021)

axis: ibs_subtype_directedstep 1 - Step 1 — All subtypes: foundational non-pharmacologic + lifestyle

Selected step "Step 1 — All subtypes: foundational non-pharmacologic + lifestyle" — Every IBS patient at diagnosis regardless of subtype

patient_education_therapeutic_relationship
first line
behavioural
triggers: ibs_any_subtype
ACG 2021 — effective clinician-patient relationship improves outcomes; positive-diagnosis communication reduces unnecessary testing
soluble_fibre_psyllium
first line
soluble_fibre
3-4 g/day soluble (psyllium/ispaghula), titrate up • PO • daily
triggers: ibs_any_subtype, especially_IBS_C
ACG 2021 strong recommendation — SOLUBLE (not insoluble) fibre improves global symptoms; NNT ~7 (Moayyedi meta-analysis)
dietitian_led_low_fodmap_with_reintroduction
first line
dietetic
4-6 wk restriction → structured reintroduction → personalisation • dietary • staged
triggers: ibs_any_subtype, bloating_or_pain_predominant
Black low-FODMAP network MA (Gut 2022 PMID 34376515) — RR global IBS symptoms not improving 0.67 (95% CI 0.48-0.91) vs habitual diet, ranked first; 13 RCTs n=944 (also Black 2021 PMID 33585949); MUST be dietitian-led with structured reintroduction to avoid nutritional/microbiome harm (BSG 2021)
physical_activity_sleep_optimisation
first line
lifestyle
triggers: ibs_any_subtype
ACG 2021 / BSG 2021 — physical activity improves IBS symptoms; sleep hygiene supports gut-brain axis

outpatient playbook — drug actions (6)

1. patient education + therapeutic relationship
Positive-diagnosis explanation; reassurance • counselling • every visit
trigger: IBS diagnosed
ACG 2021 — improves outcomes, reduces over-investigation
2. soluble fibre (psyllium)
3-4 g/day soluble, titrate • PO • daily
trigger: All subtypes, especially IBS-C
ACG 2021 strong recommendation (NNT ~7)
3. dietitian-led low-FODMAP
4-6 wk restriction → structured reintroduction • dietary • staged
trigger: Bloating/pain predominant
Black 2021 PMID 33585949 — must be dietitian-led with reintroduction
4. IBS-C: PEG 3350 then secretagogue
PEG 17 g/day; linaclotide 290 mcg daily • PO • daily
trigger: IBS-C inadequate response to fibre/diet
ACG 2021; Chey/Rao PMID 22986437/22986440
5. IBS-D: loperamide then rifaximin
Loperamide 2 mg PRN; rifaximin 550 mg TID × 14 d • PO • PRN / course
trigger: IBS-D inadequate response to fibre/diet
ACG 2021; TARGET Pimentel NEJM 2011 PMID 21208106
6. pain/global: peppermint oil → low-dose TCA
Enteric peppermint 0.2-0.4 mL TID; amitriptyline 10 mg nightly titrate • PO • TID / nightly
trigger: Persistent pain/global symptoms
ACG 2021; ATLANTIS Lancet 2023 PMID 37858323

Auto-drafted A&P note

outpatient

Subjective

- Possible entry pathways: Recurrent abdominal pain related to defecation / bowel-habit change (Rome IV positive-diagnosis trigger); Chronic altered bowel habit — diarrhoea / constipation / mixed ± bloating (Rome IV); Existing IBS on problem list (subtype review / refractory-symptom visit) (ACG 2021).

Objective

- No vitals, labs, or imaging entered for this encounter.

Assessment

**Irritable Bowel Syndrome (Rome IV; IBS-D / IBS-C / IBS-M / IBS-U; post-infectious IBS)** (gi.ibs.core.v1).
Phenotype framing: Distinguish IBS subtype from IBD (Crohn/UC), coeliac disease, microscopic colitis, bile-acid diarrhoea, colorectal cancer, lactose/carbohydrate malabsorption, SIBO, functional diarrhoea/constipation (no pain criterion), functional dyspepsia overlap, centrally-mediated abdominal pain syndrome, endocrine causes (thyroid, diabetic enteropathy). Confirm IBS subtype (IBS-D / IBS-C / IBS-M / IBS-U) and post-infectious phenotype (ACG 2021; Rome IV)
Scope: Apply Rome IV POSITIVE diagnosis — recurrent abdominal pain ≥1 day/week in the last 3 months, onset ≥6 months ago, with ≥2 of: related to defecation / change in stool frequency / change in stool form. Assign subtype by predominant Bristol Stool Form (IBS-D >25% type 6-7 & <25% type 1-2; IBS-C >25% type 1-2 & <25% type 6-7; IBS-M both >25%; IBS-U insufficient abnormal stools). NOT a diagnosis of exclusion (ACG 2021; Rome IV)

No severity triggers fired against current inputs.

Plan

Regimen axis: **IBS subtype-directed therapy (ACG 2021 + AGA IBS-C/IBS-D 2022 + BSG 2021)** — step "Step 1 — All subtypes: foundational non-pharmacologic + lifestyle".
1. patient_education_therapeutic_relationship (behavioural, first line) — ACG 2021 — effective clinician-patient relationship improves outcomes; positive-diagnosis communication reduces unnecessary testing
2. soluble_fibre_psyllium 3-4 g/day soluble (psyllium/ispaghula), titrate up PO daily (soluble_fibre, first line) — ACG 2021 strong recommendation — SOLUBLE (not insoluble) fibre improves global symptoms; NNT ~7 (Moayyedi meta-analysis)
3. dietitian_led_low_fodmap_with_reintroduction 4-6 wk restriction → structured reintroduction → personalisation dietary staged (dietetic, first line) — Black low-FODMAP network MA (Gut 2022 PMID 34376515) — RR global IBS symptoms not improving 0.67 (95% CI 0.48-0.91) vs habitual diet, ranked first; 13 RCTs n=944 (also Black 2021 PMID 33585949); MUST be dietitian-led with structured reintroduction to avoid nutritional/microbiome harm (BSG 2021)
4. physical_activity_sleep_optimisation (lifestyle, first line) — ACG 2021 / BSG 2021 — physical activity improves IBS symptoms; sleep hygiene supports gut-brain axis

Setting playbook (outpatient) — Primary-care positive diagnosis (Rome IV), minimal testing, alarm-feature screen, subtype-directed first-line therapy + education (ACG 2021; BSG 2021)
5. patient education + therapeutic relationship Positive-diagnosis explanation; reassurance counselling every visit — IBS diagnosed (ACG 2021 — improves outcomes, reduces over-investigation)
6. soluble fibre (psyllium) 3-4 g/day soluble, titrate PO daily — All subtypes, especially IBS-C (ACG 2021 strong recommendation (NNT ~7))
7. dietitian-led low-FODMAP 4-6 wk restriction → structured reintroduction dietary staged — Bloating/pain predominant (Black 2021 PMID 33585949 — must be dietitian-led with reintroduction)
8. IBS-C: PEG 3350 then secretagogue PEG 17 g/day; linaclotide 290 mcg daily PO daily — IBS-C inadequate response to fibre/diet (ACG 2021; Chey/Rao PMID 22986437/22986440)
9. IBS-D: loperamide then rifaximin Loperamide 2 mg PRN; rifaximin 550 mg TID × 14 d PO PRN / course — IBS-D inadequate response to fibre/diet (ACG 2021; TARGET Pimentel NEJM 2011 PMID 21208106)
10. pain/global: peppermint oil → low-dose TCA Enteric peppermint 0.2-0.4 mL TID; amitriptyline 10 mg nightly titrate PO TID / nightly — Persistent pain/global symptoms (ACG 2021; ATLANTIS Lancet 2023 PMID 37858323)

Non-pharmacologic actions:
- Dietitian referral for structured low-FODMAP (BSG 2021)
- Physical activity + sleep optimisation (ACG 2021)
- CBT / gut-directed hypnotherapy referral if refractory or psychological comorbidity (ACG 2021)
- Self-management education + symptom diary (Bristol stool form)
- Reassess for emergent alarm features at each visit (ACG 2021)

AVOID / contraindication checks:
- Eluxadoline contraindicated in cholecystectomy / sphincter of Oddi dysfunction / prior pancreatitis / >3 alcoholic drinks per day / severe hepatic impairment (FDA pancreatitis safety signal; AGA IBS D 2022 PMID 35738725)
- Alosetron REMS — women with severe refractory IBS D only; ischaemic colitis + serious constipation complications; stop for constipation or rectal bleeding (ACG 2021)
- TCA (amitriptyline/nortriptyline/desipramine) — cardiac conduction (baseline ECG if risk), anticholinergic burden, urinary retention, fall/sedation risk in elderly (STOPP); constipating — avoid in IBS C
- Secretagogues (linaclotide/plecanatide/lubiprostone) CONTRAINDICATED in known/suspected mechanical GI obstruction and in paediatric patients <6 yr (linaclotide boxed warning age in younger children)
- Tegaserod contraindicated with history of cardiovascular ischaemic events (MI/stroke/TIA/angina) and in patients ≥65 / severe renal or hepatic impairment (ACG 2021)
- Rifaximin / secretagogue renal hepatic dose review via calc.ckd_epi_2021 (KDIGO 2024)
- Peppermint oil non enteric coated worsens GERD/heartburn — use enteric coated formulation only (ACG 2021)
- Special_pop:PREGNANCY/LACTATION — diet/fibre/PEG first line; loperamide short term only; AVOID eluxadoline + alosetron + rifaximin (no safety data / animal teratogenicity); defer secretagogues; TCA/SSRI not for IBS indication in pregnancy (Medical Letter PMID 32324174; ACG 2021)
- Special_pop:ELDERLY — amitriptyline + dicyclomine + hyoscyamine on STOPP/Beers (anticholinergic burden, falls, retention, delirium, constipation); prefer low dose nortriptyline/desipramine; tegaserod CONTRAINDICATED ≥65 yr (STOPP v3 O'Mahony 2023; ACG 2021)
- Special_pop:RENAL — rifaximin safe (minimal absorption); secretagogue caution in severe CKD; recheck eGFR (calc.ckd_epi_2021) before TCA/SSRI escalation (KDIGO 2024)
- Special_pop:HEPATIC — eluxadoline CONTRAINDICATED Child Pugh C, 75 mg if mild moderate; rifaximin caution Child Pugh C; TCA/SSRI start low (Lembo NEJM 2016 PMID 26789872; ACG 2021)
- Special_pop:PAEDIATRIC — distinct Rome IV paediatric criteria; do NOT apply adult pathway/pharmacology — route to paediatric GI
- Special_pop:POST INFECTIOUS — distinct natural history (Klem 2017 PMID 28069350, OR 4.2 [3.1 5.7] ≤12 mo post enteritis); prognosticate gradual resolution; avoid over investigation

Monitoring

Regimen monitoring:
- Symptom + Bristol stool form response at 4-12 wk per agent (ACG 2021)
- Eluxadoline — counsel on pancreatitis red flags (severe epigastric/RUQ pain ± vomiting), discontinue immediately (AGA IBS-D 2022)
- Alosetron — monitor for ischaemic colitis (new/worsening abdominal pain, rectal bleeding) and severe constipation; stop drug (ACG 2021)
- TCA/SSRI — QTc at higher doses, anticholinergic AEs, PHQ-9/GAD-7 trend, suicidality re-screen (ACG 2021)
- Rifaximin — symptom recurrence triggers retreatment decision (TARGET-3 Lembo PMID 27528177)
- Renal function for secretagogue/rifaximin dosing in CKD (calc.ckd epi 2021)

Setting (outpatient) monitoring:
- Symptom + Bristol stool form response at 4-12 wk per agent (ACG 2021)
- PHQ-9 / GAD-7 trend on neuromodulator therapy (ACG 2021)
- Eluxadoline pancreatitis / alosetron ischaemic-colitis red-flag counselling (AGA 2022)
- Renal function for secretagogue/rifaximin dosing in CKD (calc.ckd_epi_2021)

Follow-up plan: Mild disease: review at 4-8 weeks then as needed. Moderate-severe / refractory: structured follow-up q4-12 weeks during therapy escalation; reinforce diet reintroduction and self-management; post-infectious IBS — counsel on gradual improvement over months-years (Klem 2017 PMID 28069350). Reassess diagnosis if alarm features emerge or response is atypical; coordinate multidisciplinary care (dietitian, psychology). SPECIAL-POPULATION MATRIX (≥6): (1) PREGNANCY/LACTATION — diet/fibre/PEG first-line; loperamide short-term only (avoid 1st trimester); AVOID eluxadoline and alosetron (no safety data + SOD/ischaemic risk), AVOID rifaximin (animal teratogenicity), defer secretagogues (linaclotide/plecanatide pregnancy data limited; lubiprostone animal loss), TCA/SSRI only if benefit outweighs risk (TCAs assoc. worse fetal outcomes — not for IBS indication in pregnancy) (Medical Letter PMID 32324174; ACG 2021). (2) ELDERLY — TCAs (amitriptyline) and antimuscarinic antispasmodics (dicyclomine/hyoscyamine) on STOPP/Beers (anticholinergic burden, falls, urinary retention, delirium, constipation) — prefer secondary-amine nortriptyline/desipramine at low dose; constipation risk amplifies in IBS-C; tegaserod CONTRAINDICATED ≥65 yr (CV ischaemic risk) (STOPP v3 O'Mahony 2023; ACG 2021). (3) RENAL IMPAIRMENT — secretagogues minimally renally cleared but caution in severe CKD; rifaximin minimal systemic absorption (safe); recheck eGFR via calc.ckd_epi_2021 before TCA/SSRI dose escalation (KDIGO 2024). (4) HEPATIC IMPAIRMENT — eluxadoline CONTRAINDICATED in severe hepatic impairment (Child-Pugh C) and dose-reduce 75 mg in mild-moderate; rifaximin caution Child-Pugh C (↑systemic exposure); TCA/SSRI hepatic metabolism — start low (Lembo NEJM 2016 PMID 26789872; ACG 2021). (5) POST-INFECTIOUS SUBGROUP — distinct natural history (OR 4.2 [3.1-5.7] within 12 mo of enteritis, gradual resolution over months-years; usually IBS-D, female/antibiotic/anxiety risk factors) — counsel on prognosis, avoid over-investigation (Klem 2017 PMID 28069350). (6) PAEDIATRIC — distinct Rome IV PAEDIATRIC functional GI criteria; do NOT apply adult IBS pathway/pharmacology → route OUT to paediatric GI. (7) COMORBID PSYCHIATRIC — bidirectional gut-brain axis (anxiety/depression both predict and worsen IBS and PI-IBS); PHQ-9/GAD-7 at baseline + follow-up, gut-brain neuromodulator + psychological-therapy selection, safety-plan on positive PHQ-9 Q9 (ACG 2021; BSG 2021; Klem 2017) (ACG 2021; BSG 2021)
- Close-out criterion: follow-up interval, self-management plan, special-population adjustments, and multidisciplinary referrals scheduled

Monitoring phase: Reassess symptom response at 4-12 weeks per agent; track Bristol stool form and pain; monitor for eluxadoline pancreatitis red flags (severe epigastric/RUQ pain), alosetron ischaemic colitis (new rectal bleeding / worsening abdominal pain) and severe constipation; renal function for secretagogue/rifaximin dosing; PHQ-9/GAD-7 trend on neuromodulator therapy; re-screen for emergent alarm features (any new alarm → re-enter RED_FLAGS organic workup) (ACG 2021; AGA 2022)

Disposition

Current setting: outpatient — Primary-care positive diagnosis (Rome IV), minimal testing, alarm-feature screen, subtype-directed first-line therapy + education (ACG 2021; BSG 2021)

Disposition criteria:
- Continue primary-care management if responding and no alarm features (ACG 2021)
- Refer to GI/neurogastroenterology for diagnostic uncertainty, alarm features, refractory disease, restricted-agent consideration (ACG 2021)
- Refer to dietetics + psychology for multidisciplinary refractory care (BSG 2021)

Escalation triggers (move to higher acuity):
- New alarm feature (rectal bleeding, weight loss, iron-deficiency anaemia, nocturnal symptoms) → organic-disease workup / GI referral (ACG 2021)
- Refractory symptoms after ≥2 therapy classes → GI / neurogastroenterology referral (ACG 2021)
- Severe psychological comorbidity / positive PHQ-9 Q9 suicidality → psychiatry, safety plan (ACG 2021)
- Severe IBS-D with dehydration / electrolyte disturbance → acute care (BSG 2021)
- Eluxadoline-associated severe epigastric/RUQ pain → ED (pancreatitis) (AGA IBS-D 2022)

Earlier-Return Triggers

Return-precaution thresholds (watch for):
- [LIFE_THREATENING] Severe epigastric/RUQ pain ± vomiting in a patient on eluxadoline — sphincter-of-Oddi spasm / pancreatitis (FDA safety signal; AGA IBS-D 2022 PMID 35738725)
- [SEVERE] Any alarm feature — age ≥50 new onset, rectal bleeding/melaena, unintentional weight loss, iron-deficiency anaemia, nocturnal or progressive symptoms, palpable mass, family history CRC/IBD/coeliac (ACG 2021; BSG 2021)
- [SEVERE] Severe depression/anxiety or positive PHQ-9 item 9 (suicidality) in an IBS patient (ACG 2021; bidirectional gut-brain axis)

Citations

- ACG 2021 IBS Clinical Guideline (Lacy AJG 2021, PMID 33315591) + BSG 2021 IBS Guideline (Vasant Gut 2021, PMID 33903147) + AGA Clinical Practice Guideline IBS-C 2022 (PMID 35738724) + IBS-D 2022 (PMID 35738725) + Rome IV criteria; depth-pass-2 2026-05-17 added van Rheenen 2010 calprotectin diagnostic MA (PMID 20634346 — the LR+ ≈23.3 organic-disease rule-in), Black secretagogue/low-FODMAP network MAs, Menees rifaximin MA, Ingrosso peppermint-oil MA, Irvine coeliac-in-IBS MA, Garsed ondansetron RCT, Lembo/Cash eluxadoline pancreatitis safety [PMID:33315591](https://pubmed.ncbi.nlm.nih.gov/33315591/)
- Cited evidence (PMID 33903147) [PMID:33903147](https://pubmed.ncbi.nlm.nih.gov/33903147/)
- Cited evidence (PMID 35738724) [PMID:35738724](https://pubmed.ncbi.nlm.nih.gov/35738724/)
- Cited evidence (PMID 35738725) [PMID:35738725](https://pubmed.ncbi.nlm.nih.gov/35738725/)
- Cited evidence (PMID 37858323) [PMID:37858323](https://pubmed.ncbi.nlm.nih.gov/37858323/)

Last reconciled with current guidelines: 2026-05-17.

References

ACG 2021 IBS Clinical Guideline (Lacy AJG 2021, PMID 33315591) + BSG 2021 IBS Guideline (Vasant Gut 2021, PMID 33903147) + AGA Clinical Practice Guideline IBS-C 2022 (PMID 35738724) + IBS-D 2022 (PMID 35738725) + Rome IV criteria; depth-pass-2 2026-05-17 added van Rheenen 2010 calprotectin diagnostic MA (PMID 20634346 — the LR+ ≈23.3 organic-disease rule-in), Black secretagogue/low-FODMAP network MAs, Menees rifaximin MA, Ingrosso peppermint-oil MA, Irvine coeliac-in-IBS MA, Garsed ondansetron RCT, Lembo/Cash eluxadoline pancreatitis safety — PMID:33315591
Cited evidence (PMID 33903147) — PMID:33903147
Cited evidence (PMID 35738724) — PMID:35738724
Cited evidence (PMID 35738725) — PMID:35738725
Cited evidence (PMID 37858323) — PMID:37858323