title: Evidence-based clinical practice guidelines for irritable bowel syndrome.
abstract: New strategies for the care of irritable bowel syndrome (IBS) are developing and several novel treatments have been globally produced. New methods of care should be customized geographically because each country has a specific medical system, life style, eating habit, gut microbiota, genes and so on. Several clinical guidelines for IBS have been proposed and the Japanese Society of Gastroenterology (JSGE) subsequently developed evidence-based clinical practice guidelines for IBS. Sixty-two clinical questions (CQs) comprising 1 definition, 6 epidemiology, 6 pathophysiology, 10 diagnosis, 30 treatment, 4 prognosis, and 5 complications were proposed and statements were made to answer to CQs. A diagnosis algorithm and a three-step treatment was provided for patients with chronic abdominal pain or abdominal discomfort and/or abnormal bowel movement. If more than one alarm symptom/sign, risk factor and/or routine examination is positive, colonoscopy is indicated. If all of them, or the subsequent colonoscopy, are/is negative, Rome III or compatible criteria is applied. After IBS diagnosis, step 1 therapy consisting of diet therapy, behavioral modification and gut-targeted pharmacotherapy is indicated for four weeks. Non-responders to step 1 therapy proceed to the second step that includes psychopharmacological agents and simple psychotherapy for four weeks. In the third step, for patients non-responsive to step 2 therapy, a combination of gut-targeted pharmacotherapy, psychopharmacological treatments and/or specific psychotherapy is/are indicated. Clinical guidelines and consensus for IBS treatment in Japan are well suited for Japanese IBS patients; as such, they may provide useful insight for IBS treatment in other countries around the world.
authors.affiliation: Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for irritable bowel syndrome", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13 Ginza, Chuo, Tokyo, 104-0061, Japan, sfukudo@med.tohoku.ac.jp.
authors.forename: Shin
authors.initials: S
authors.lastname: Fukudo
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kaneko
authors.forename: Hirotada
authors.initials: H
authors.lastname: Akiho
authors.forename: Masahiko
authors.initials: M
authors.lastname: Inamori
authors.forename: Yuka
authors.initials: Y
authors.lastname: Endo
authors.forename: Toshikatsu
authors.initials: T
authors.lastname: Okumura
authors.forename: Motoyori
authors.initials: M
authors.lastname: Kanazawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kamiya
authors.forename: Ken
authors.initials: K
authors.lastname: Sato
authors.forename: Toshimi
authors.initials: T
authors.lastname: Chiba
authors.forename: Kenji
authors.initials: K
authors.lastname: Furuta
authors.forename: Shigeru
authors.initials: S
authors.lastname: Yamato
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Arakawa
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Fujiyama
authors.forename: Takeshi
authors.initials: T
authors.lastname: Azuma
authors.forename: Kazuma
authors.initials: K
authors.lastname: Fujimoto
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Mine
authors.forename: Soichiro
authors.initials: S
authors.lastname: Miura
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Kinoshita
authors.forename: Kentaro
authors.initials: K
authors.lastname: Sugano
authors.forename: Tooru
authors.initials: T
authors.lastname: Shimosegawa
mesh_terms: D055317:Evidence-Based Practice / Q000379:methods; D020022:Genetic Predisposition to Disease; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D001523:Mental Disorders / Q000150:complications; D064307:Microbiota / Q000502:physiology; D018377:Neurotransmitter Agents / Q000502:physiology; D015995:Prevalence; D011379:Prognosis; D011788:Quality of Life; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications
chemical_list: D018377:Neurotransmitter Agents