Evidence-based clinical practice guidelines for irritable bowel syndrome 2020

Shin Fukudo, Toshikatsu Okumura, Masahiko Inamori, Yusuke Okuyama, Motoyori Kanazawa, Takeshi Kamiya, Ken Sato, Akiko Shiotani, Yuji Naito, Yoshiko Fujikawa, Ryota Hokari, Tastuhiro Masaoka, Kazuma Fujimoto, Hiroshi Kaneko, Akira Torii, Kei Matsueda, Hiroto Miwa, Nobuyuki Enomoto, Tooru Shimosegawa, Kazuhiko Koike

Research output: Contribution to journalReview articlepeer-review

17 Citations (Scopus)


Managing irritable bowel syndrome (IBS) has attracted international attention because single-agent therapy rarely relieves bothersome symptoms for all patients. The Japanese Society of Gastroenterology (JSGE) published the first edition of evidence-based clinical practice guidelines for IBS in 2015. Much more evidence has accumulated since then, and new pharmacological agents and non-pharmacological methods have been developed. Here, we report the second edition of the JSGE-IBS guidelines comprising 41 questions including 12 background questions on epidemiology, pathophysiology, and diagnostic criteria, 26 clinical questions on diagnosis and treatment, and 3 questions on future research. For each question, statements with or without recommendations and/or evidence level are given and updated diagnostic and therapeutic algorithms are provided based on new evidence. Algorithms for diagnosis are requisite for patients with chronic abdominal pain or associated symptoms and/or abnormal bowel movement. Colonoscopy is indicated for patients with one or more alarm symptoms/signs, risk factors, and/or abnormal routine examination results. The diagnosis is based on the Rome IV criteria. Step 1 therapy consists of diet therapy, behavioral modification, and gut-targeted pharmacotherapy for 4 weeks. For non-responders, management proceeds to step 2 therapy, which includes a combination of different mechanistic gut-targeted agents and/or psychopharmacological agents and basic psychotherapy for 4 weeks. Step 3 therapy is for non-responders to step 2 and comprises a combination of gut-targeted pharmacotherapy, psychopharmacological treatments, and/or specific psychotherapy. These updated JSGE-IBS guidelines present best practice strategies for IBS patients in Japan and we believe these core strategies can be useful for IBS diagnosis and treatment globally.

Original languageEnglish
Pages (from-to)193-217
Number of pages25
JournalJournal of gastroenterology
Issue number3
Publication statusPublished - 2021 Mar
Externally publishedYes


  • 5-HT3 antagonists
  • 5-HT4 agonists
  • Antibiotics
  • Antidepressant
  • Brain-gut interactions
  • Complications
  • Diagnosis
  • Epidemiology
  • Functional bowel disorder (FBD)
  • Functional gastrointestinal disorders (FGIDs)
  • Infection
  • Inflammation
  • Intestinal secretagogues (gut epithelial modifier)
  • Irritable bowel syndrome (IBS)
  • Microbiota
  • Mucosal permeability
  • Pathophysiology
  • Probiotics
  • Prognosis
  • Psychosocial stress
  • Psychotherapy
  • Rome IV criteria
  • Treatment

ASJC Scopus subject areas

  • Gastroenterology


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