Evidence-based clinical practice guidelines for irritable bowel syndrome

Shin Fukudo, Hiroshi Kaneko, Hirotada Akiho, Masahiko Inamori, Yuka Endo, Toshikatsu Okumura, Motoyori Kanazawa, Takeshi Kamiya, Ken Sato, Toshimi Chiba, Kenji Furuta, Shigeru Yamato, Tetsuo Arakawa, Yoshihide Fujiyama, Takeshi Azuma, Kazuma Fujimoto, Tetsuya Mine, Soichiro Miura, Yoshikazu Kinoshita, Kentaro SuganoTooru Shimosegawa

Research output: Contribution to journalReview articlepeer-review

90 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)11-30
Number of pages20
JournalJournal of gastroenterology
Issue number1
Publication statusPublished - 2014 Jan


  • 5-HT agonist
  • 5-HT antagonist
  • Antibiotics
  • Antidepressant
  • Brain-gut interactions
  • Complications
  • Definition
  • Diagnosis
  • Epidemiology
  • Functional bowel disorder (FBD)
  • Functional gastrointestinal disorders (FGIDs)
  • Gut epithelial modifier
  • Infection
  • Inflammation
  • Microbiota
  • Mucosal permeability
  • Pathophysiology
  • Probiotics
  • Prognosis
  • Psychosocial stress
  • Psychotherapy
  • Rome III criteria
  • Treatment

ASJC Scopus subject areas

  • Gastroenterology


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