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Guidelines registry — irritable bowel syndrome¶
Catalogue of clinical practice guidelines, consensus statements and position papers worldwide. PMIDs already in this file on 2026-09-02 were resolved then and were not re-fetched. PMID 42066057 was resolved live on 2026-09-30. The NICE CG61 overview URL was re-read on 2026-09-30. The synthesis of what these documents recommend, and where they disagree, lives in wiki/guidelines.md; this file records the documents themselves. The 2026-09-30 addition is an abstract-level catalogue entry. It does not rewrite that synthesis.
Status values: current = most recent version from that body; superseded by → = replaced by a named later document; historical = of record only.
Master table¶
| # | Body | Year | Region | Scope | Citation / PMID | Status |
|---|---|---|---|---|---|---|
| 1 | American College of Gastroenterology (ACG) | 2021 | USA | Full management guideline; 25 clinical questions (9 diagnostic, 16 therapeutic); GRADE + modified Delphi | Lacy BE, et al. Am J Gastroenterol. 2021;116(1):17-44. PMID 33315591 | current |
| 2 | ACG monograph | 2018 | USA | Evidence monograph on IBS management (systematic review underpinning ACG guidance) | Ford AC, et al. Am J Gastroenterol. 2018;113(Suppl 2):1-18. PMID 29950604 | superseded by → ACG 2021 guideline (#1) as the recommendation document; retains value as a systematic review |
| 3 | British Society of Gastroenterology (BSG) | 2021 | UK | Full management guideline; commissioned its own trial-based and network meta-analyses; GRADE | Vasant DH, et al. Gut. 2021;70(7):1214-1240. PMID 33903147 | current |
| 4 | BSG | 2007 | UK | Mechanisms and practical management | Spiller R, et al. Gut. 2007;56(12):1770-98. PMID 17488783 | superseded by → BSG 2021 (#3) |
| 5 | BSG | 2000 | UK | First BSG IBS guideline | Jones J, et al. Gut. 2000;47 Suppl 2:ii1-19. PMID 11053260 | superseded by → BSG 2007 (#4) → BSG 2021 (#3) |
| 6 | American Gastroenterological Association (AGA) | 2022 | USA | Pharmacological management of IBS-C only; 9 recommendations; GRADE | Chang L, et al. Gastroenterology. 2022;163(1):118-136. PMID 35738724 | current |
| 7 | AGA | 2022 | USA | Pharmacological management of IBS-D only; 8 recommendations; GRADE | Lembo A, et al. Gastroenterology. 2022;163(1):137-151. PMID 35738725 | current |
| 8 | NICE (National Collaborating Centre for Nursing and Supportive Care) | 2008 | UK | CG61: diagnosis and management in primary care | NICE — "Irritable bowel syndrome in adults: diagnosis and management", https://www.nice.org.uk/guidance/cg61, accessed 2026-10-21 | updated 2017 (#10) |
| 9 | NICE | 2015 | UK | Addendum to CG61: dietary/lifestyle advice and pharmacological therapy | NICE CG61 evidence history, https://www.nice.org.uk/guidance/cg61/evidence, accessed 2026-09-02 | incorporated into → NICE 2017 (#10) |
| 10 | NICE | 2017 (reviewed 2025) | UK | CG61 as updated: diagnosis and management in adults | NICE — "Irritable bowel syndrome in adults: diagnosis and management", https://www.nice.org.uk/guidance/cg61, accessed 2026-10-21 | current; last reviewed 30 April 2025; NICE will not update the clinical-management section |
| 11 | NICE | 2021 | UK | Chronic pain (primary and secondary) in over-16s — adjacent; used alongside the IBS guideline | NICE NG193, https://www.nice.org.uk/guidance/ng193, accessed 2026-09-02 | current (adjacent) |
| 12 | Japanese Society of Gastroenterology (JSGE) | 2020 (published 2021) | Japan | 41 questions (12 background, 26 clinical, 3 research); three-step therapeutic algorithm | Fukudo S, et al. J Gastroenterol. 2021;56(3):193-217. PMID 33538894 (erratum PMID 37752291) | current |
| 13 | JSGE | 2015 | Japan | First edition | Fukudo S, et al. J Gastroenterol. 2015;50(1):11-30. PMID 25500976 | superseded by → JSGE 2020 (#12) |
| 14 | Korean Society of Neurogastroenterology and Motility | 2025 | Korea | Seoul Consensus; 22 recommendations (3 definition/risk, 4 diagnostic, 2 general management, 13 medical treatment); de novo + adaptation, modified Delphi | Choi Y, et al. J Neurogastroenterol Motil. 2025;31(2):133-169. PMID 40205893 | current |
| 15 | Korean Society of Neurogastroenterology and Motility | 2017 (published 2018) | Korea | Revised edition | Song KH, et al. J Neurogastroenterol Motil. 2018;24(2):197-215. PMID 29605976 | superseded by → Seoul Consensus 2025 (#14) |
| 16 | Korean (earlier) | 2011 | Korea | Treatment guidelines | Kwon JG, et al. Korean J Gastroenterol. 2011;57(2):82-99. PMID 21350320 | superseded by → #15 → #14 |
| 17 | Italian joint consensus (SIGE, SINGEM, AIGO, SIED, SIMG, SIGENP, SIP) | 2023 | Italy | Full management guideline across seven societies | Barbara G, et al. Dig Liver Dis. 2023;55(2):187-207. PMID 36517261 | current |
| 18 | United European Gastroenterology / European Society for Neurogastroenterology and Motility (UEG/ESNM) | 2022 | Europe | Functional bowel disorders with diarrhoea | Savarino E, et al. United European Gastroenterol J. 2022;10(6):556-584. PMID 35695704 | current |
| 19 | Asian Pacific Association of Gastroenterology (APAGE) | 2023 | Asia-Pacific | Functional dyspepsia overlapping other GI symptoms, including IBS; management algorithms | Gwee KA, et al. J Gastroenterol Hepatol. 2023;38(2):197-209. PMID 36321167 | current |
| 20 | Asian Consensus (second) | 2019 | Asia | Regional consensus on IBS | Gwee KA, et al. J Neurogastroenterol Motil. 2019;25(3):343-362. PMID 31327218 | current |
| 21 | Asociación Mexicana de Gastroenterología | 2024 (published 2025) | Mexico | Position statement, pharmacological treatment only; 14 experts; explicitly conditioned on Mexican formulary availability | Remes-Troche JM, et al. Rev Gastroenterol Mex (Engl Ed). 2025;90(1):77-110. PMID 40307155 | current |
| 22 | World Gastroenterology Organisation (WGO) | 2015 (published 2016) | Global | Global perspective with resource-tiered cascades | Quigley EM, et al. J Clin Gastroenterol. 2016;50(9):704-13. PMID 27623513 | current (dated) |
| 23 | German consensus (S3) | 2011 | Germany | Definition, pathophysiology and management | Layer P, et al. Z Gastroenterol. 2011;49(2):237-93. PMID 21287438 | superseded by → German S3 2021 (#34) |
| 24 | British Dietetic Association (BDA) | 2016 update | UK | Dietary management of IBS in adults | McKenzie YA, et al. J Hum Nutr Diet. 2016;29(5):549-75. PMID 27272325 | current |
| 25 | BDA | 2016 update | UK | Probiotics in IBS management (companion review) | McKenzie YA, et al. J Hum Nutr Diet. 2016;29(5):576-92. PMID 27265510 | current |
| 26 | BDA | 2012 | UK | First BDA IBS dietary guideline | McKenzie YA, et al. J Hum Nutr Diet. 2012;25(3):260-74. PMID 22489905 | superseded by → BDA 2016 (#24) |
| 27 | BDA | 2025 | UK | Dietary management of chronic constipation in adults — adjacent | Dimidi E, et al. J Hum Nutr Diet. 2025;38(5):e70133. PMID 41081513 | current (adjacent) |
| 28 | ACG | 2020 | USA | Small intestinal bacterial overgrowth — adjacent, defines the construct and its testing | Pimentel M, et al. Am J Gastroenterol. 2020;115(2):165-178. PMID 32023228 | current (adjacent) |
| 29 | North American Consensus | 2017 | N America | Hydrogen and methane breath testing; 26 consensus statements | Rezaie A, et al. Am J Gastroenterol. 2017;112(5):775-784. PMID 28323273 | current, contested — see disagreements below |
| 30 | ESPGHAN / NASPGHAN | 2025 | Europe / N America | Paediatric IBS and functional abdominal pain, ages 4–18 | Groen J, et al. J Pediatr Gastroenterol Nutr. 2025;81(2):442-471. PMID 40444524 | current (paediatric) |
| 31 | Italian paediatric joint consensus | 2024 | Italy | Paediatric IBS, children and adolescents | Di Nardo G, et al. Ital J Pediatr. 2024;50:51. PMID 38486305 | current (paediatric) |
| 32 | Consensus practice guidelines (Fass) | 2001 | USA | Evidence- and consensus-based guidelines for diagnosis | Fass R, et al. Arch Intern Med. 2001;161(17):2081-8. PMID 11570936 | historical |
| 33 | Israeli Gastroenterology Association, Neurogastroenterology and Motility Section | 2026 | Israel | National position paper for general practitioners and adult and paediatric gastroenterologists | Shibli F, et al. J Clin Gastroenterol. 2026. PMID 42066057 | current for that body; abstract-level entry only, grades not extracted |
| 34 | DGVS / DGNM (S3; AWMF 021/016) | 2021 | Germany | Updated definition, pathophysiology, diagnosis and treatment | Layer P, et al. Z Gastroenterol. 2021;59(12):1323-1415. PMID 34891206; doi:10.1055/a-1591-4794 | Latest version posted by DGVS; society page says revision is in progress (accessed 2026-10-14). Historical omission corrected, not a new 2026 publication |
| 35 | Canadian Association of Gastroenterology (CAG) | 2019 | Canada | IBS management; GRADE consensus | Moayyedi P, et al. J Can Assoc Gastroenterol. 2019;2(1):6-29. PMID 31294724 | Published guideline; historical omission corrected. No successor identified in this sweep's dated PubMed guideline query |
| 36 | Argentine expert consensus | 2026 | Argentina | Adjacent: breath testing and microbial-overgrowth management in DGBI, including IBS-C | Soifer LO, et al. Rev Gastroenterol Mex (Engl Ed). 2026. PMID 42816255 | New catalogue entry; abstract-level only, full text inaccessible; not a comprehensive IBS management guideline |
Rome criteria are diagnostic standards rather than management guidelines and are catalogued on wiki/diagnosis-and-rome-criteria.md; the primary documents are Rome III (Longstreth 2006, PMID 16678561), Rome IV (Drossman 2016, PMID 27144617; Palsson 2016, PMID 27144634) and Rome V (Drossman 2026, PMID 42031435; Sperber 2026, PMID 42613194).
Per-guideline entries¶
ACG 2021 (PMID 33315591)¶
First ACG guideline for IBS. Twenty-five questions assessed after comprehensive literature search; consensus by modified Delphi; GRADE. Explicit endorsements include: positive diagnostic strategy over exclusion; serologic testing for coeliac disease in IBS with diarrhoea; faecal calprotectin in suspected IBS with diarrhoea; a limited trial of a low-FODMAP diet for global symptoms; chloride channel activators and guanylate cyclase activators for IBS-C; rifaximin for IBS-D; gut-directed psychotherapy for global symptoms.
BSG 2021 (PMID 33903147)¶
Explicitly re-classifies IBS as a disorder of gut–brain interaction rather than a functional gastrointestinal disorder, and updates a series of trial-based and network meta-analyses commissioned for the guideline itself. GRADE throughout. Identifies treatments in development and areas of unmet research need. Note that the authoring group overlaps substantially with the group producing most of the meta-analyses cited across this knowledge base — a strength for internal consistency and a limitation for independence.
AGA 2022, IBS-C (PMID 35738724)¶
Reviewed tenapanor, plecanatide, linaclotide, tegaserod, lubiprostone, polyethylene glycol laxatives, tricyclic antidepressants, SSRIs and antispasmodics. Nine recommendations: strong for linaclotide (high certainty); conditional for tenapanor, plecanatide, tegaserod and lubiprostone (moderate certainty); conditional for PEG laxatives, tricyclics and antispasmodics (low certainty); conditional against SSRIs (low certainty).
AGA 2022, IBS-D (PMID 35738725)¶
Reviewed eluxadoline, rifaximin, alosetron, loperamide, tricyclics, SSRIs and antispasmodics. Eight recommendations, none strong: conditional for eluxadoline, rifaximin and alosetron (moderate certainty); conditional for tricyclics and antispasmodics (low certainty); conditional for loperamide (very low certainty); conditional against SSRIs (low certainty).
NICE CG61, as updated 2017 (official URL checked 2026-10-21)¶
Primary-care-oriented. Aims stated as: provide positive diagnostic criteria; provide guidance on clinical and cost-effective management in primary care; determine indications for referral. Frames referral to secondary care as occurring only after identification of red flags, cross-referring to the NICE suspected-cancer guideline. Notes that some recommended medicines are used off-label and require documented informed consent. Includes the 2015 addendum's updated dietary/lifestyle and pharmacological recommendations. The overview page, re-read on 2026-10-21, still says last reviewed 30 April 2025 and that the clinical-management section will not be updated.
Israeli Gastroenterology Association 2026 (PMID 42066057)¶
Abstract-level record only. The position paper is written for general practitioners and for adult and paediatric gastroenterologists. The abstract says the working groups reviewed patient education, dietary modification (particularly low FODMAP), antispasmodics, probiotics, rifaximin, linaclotide, neuromodulators, cognitive behavioural therapy, gut-directed hypnotherapy and complementary approaches, developed a structured algorithm from treatments available locally, and stresses empathic biopsychosocial communication. It does not report recommendation grades, and none are inferred here. The abstract's "around 4%" global prevalence is not adopted in the statistics sheet. No volume or pages were in the PubMed record on 2026-09-30.
JSGE 2020 (PMID 33538894)¶
Forty-one questions. Diagnosis based on Rome IV. Colonoscopy indicated for one or more alarm symptoms/signs, risk factors or abnormal routine results. Unusually, specifies a three-step therapeutic algorithm: step 1 — diet, behavioural modification and gut-targeted pharmacotherapy for 4 weeks; step 2 — combinations of different mechanistic gut-targeted agents and/or psychopharmacological agents plus basic psychotherapy for 4 weeks; step 3 — combined gut-targeted pharmacotherapy, psychopharmacology and specific psychotherapy.
Seoul Consensus 2025 (PMID 40205893)¶
Twenty-two recommendations developed by combined de novo and adaptation methods, with modified Delphi consensus: 3 on definition and risk factors, 4 on diagnostic modalities and strategies, 2 on general management, 13 on medical treatment. Advantages, disadvantages and precautions detailed per statement.
AMG Mexico 2024/2025 (PMID 40307155)¶
The most explicitly formulary-conditioned document in this registry. Antispasmodics (alone or combined) first-line for pain; loperamide for diarrhoea in IBS-D; laxatives for constipation in IBS-C; 5-HT4 agonists (prucalopride, mosapride) in IBS-C; ondansetron in IBS-D; linaclotide noted as the only secretagogue available in Mexico; rifaximin-alpha highlighted for IBS-D and mixed IBS; probiotics conditionally recommended as adjuvants "due to heterogeneous evidence"; neuromodulators second-line for pain; mesalazine possible in IBS-D on weak evidence.
APAGE 2023 (PMID 36321167)¶
The only document in this registry that provides management algorithms for overlap: functional dyspepsia with GERD, epigastric pain syndrome with IBS, postprandial distress syndrome with IBS, and functional dyspepsia with constipation. Written on the premise that symptom-category overlap "frequently occurs and has a negative impact on treatment outcomes" and that "there is a lack of guidance on their management."
WGO 2015/2016 (PMID 27623513)¶
Global-perspective document built around resource-tiered cascades, intended for settings where the diagnostics and drugs assumed by North American and European guidelines are unavailable. Now a decade old and predating Rome IV's prevalence effects, the AGA drug guidelines, ATLANTIS, CARIBS, DOMINO and Rome V.
Disagreements and gaps¶
| # | Disagreement | Positions | Where it bites |
|---|---|---|---|
| D1 | SSRIs | AGA: conditional recommendation against, low certainty, in both IBS-C (#6) and IBS-D (#7). The 2025 updated meta-analysis finds SSRIs superior to placebo for abdominal pain (RR 0.74, 0.56–0.99; 7 RCTs, 324 patients) and explicitly highlights their potential (Khasawneh 2025, PMID 40258375) | gut-brain-neuromodulators |
| D2 | Bile acid testing in IBS-D | BSG-aligned practice guidance recommends SeHCAT because roughly a third of IBS-D patients have bile acid diarrhoea (Black 2020, PMID 32133113); ACG (#1) does not make it routine. Disagreement is driven by test availability — SeHCAT is largely unavailable outside Europe and Canada (Valentin 2016, PMID 26347530) | differential-diagnosis-and-exclusion |
| D3 | Breath testing for SIBO | ACG maintains a dedicated SIBO guideline codifying testing (#28) and the North American Consensus (#29) sets thresholds; BSG-aligned guidance states there is "no role for routine hydrogen breath tests" in suspected IBS (Black 2020, PMID 32133113) | rifaximin-and-the-sibo-question |
| D4 | SIBO diagnostic threshold | North American Consensus: hydrogen rise ≥20 ppm (#29). Asia-Pacific: ≥12 ppm. In 90 consecutive IBS patients these gave 37.8% and 44.4% prevalence, and only the Asia-Pacific criterion tracked symptom severity (Loh 2026, PMID 42235989) | rifaximin-and-the-sibo-question |
| D5 | Independence of the SIBO consensus | The North American Consensus (#29) attracted a published conflict-of-interest challenge (Maltz 2017, PMID 29215615) and a challenge to the diagnostic role of lactulose (Usai-Satta 2018, PMID 29535443, with reply PMID 29535445). Its own disclosure statement records support in part from a breath-testing laboratory and institutional licensing agreements | rifaximin-and-the-sibo-question |
| D6 | Strength asymmetry by subtype | AGA IBS-C contains one strong recommendation (linaclotide, high certainty); AGA IBS-D contains none, and rates loperamide — the world's most-used IBS-D drug — at very low certainty | constipation-predominant-pharmacotherapy, diarrhoea-predominant-pharmacotherapy |
| D7 | Formulary conditioning | AMG Mexico (#21) recommends ondansetron for IBS-D, which is licensed for IBS nowhere; WGO (#22) formalises resource tiers; most Western guidelines assume full availability | guidelines |
Gaps — what no current guideline addresses¶
- Rome V. Published May 2026 (Drossman 2026, PMID 42031435). No guideline in this registry has been revised against it. A date-restricted PubMed search from 2026-09-02 through 2026-09-30 returned no Rome V IBS guideline. Its first accuracy study reports sensitivity 66.1%, below both Rome III and Rome IV (Staller 2026, PMID 42392123).
- Sequencing diet before drugs. CARIBS (Nybacka 2024, PMID 38643782) and DOMINO (Carbone 2022, PMID 35483886) both post-date or narrowly precede the current guidelines and neither is reflected in a sequencing recommendation.
- Overlap with functional dyspepsia outside APAGE (#19), despite 34.6–55.3% co-occurrence.
- Open-label placebo, despite three positive randomised trials (Kaptchuk 2010, PMID 21203519; Lembo 2021, PMID 33605656; Nurko 2022, PMID 35099543).
- Neuromodulator versus behavioural therapy sequencing; targeted searches on 2026-09-02 retrieved no head-to-head trial that could support a direct sequence, and a date-restricted PubMed search through 2026-09-30 returned none.
- German S3 history corrected (2026-10-14). The 2021 update (#34) supersedes #23. The PubMed title is
[Not Available]; its DOI resolves in Crossref to the complete guideline title, and the DGVS primary page labels it June 2021 and says revision is in progress. The earlier dated-search miss was not evidence that the update was unpublished. - Canadian history corrected (2026-10-14). The 2019 CAG guideline (#35) is now catalogued after an unrestricted historical PubMed query and full-text retrieval. Future successor checks must search from 2019, rather than keep asking whether a Canadian guideline exists.
Watch list¶
| What to watch | Why | Expected trigger |
|---|---|---|
| ACG, BSG, AGA and NICE revisions incorporating Rome V | Rome V changes case ascertainment (κ 0.36–0.55 vs predecessors) and could shift every effect estimate's denominator | Publication of any Rome V-based guideline revision |
| Guideline uptake of diet-first positioning | CARIBS and DOMINO both favour diet over drugs; DOMINO's authors state diet "should be considered the first-line treatment for IBS in primary care" | Next ACG/BSG/NICE revision |
| SSRI recommendation reversal | Khasawneh 2025 (PMID 40258375) postdates AGA 2022 and points the other way | Next AGA pharmacological guideline |
| SIBO guidance convergence | North American and Asia-Pacific thresholds differ; BSG-aligned guidance rejects routine testing altogether | Any joint or revised breath-testing consensus |
| Camlipixant (P2X3 antagonist) phase 2 in IBS-D/IBS-M (NCT07519395), plus parallel brenipatide phase 2 programmes in IBS-D and IBS-C (NCT07545759; NCT07545772) | Large industry programmes testing mechanisms beyond currently licensed IBS drugs | Trial readouts |
| Norwegian donor vs autologous FMT phase 3 (NCT04691544, n=450) | Published and negative on a ≥75-point IBS-SSS endpoint at 90 days (40% vs 38%; difference 1.9 percentage points, 95% CI −8.1 to 12.0; p=0.76; Johnsen 2026, PMID 42785338). The registry record was still active, not recruiting, with no results posted, on 2026-09-30 (last update 2024-02-26). This does not put FMT into any guideline | Full text, if secondary or ≥50-point analyses differ from the abstract; a guideline that cites the trial |
| Successors to German S3 2021 and CAG 2019 | Both historical documents are now catalogued (#34–35); DGVS says its guideline is being revised | Posted revision or society announcement |
Documents present on 2026-09-02 were compiled that day and their PMIDs were not re-fetched. The Israeli entry, the NICE access date, and the dated absences refreshed above were checked live on 2026-09-30. Statements of absence reflect those searches only.
2026-10-14 provenance. Three documents added (#34–36), taking this catalogue to 36. PubMed and Crossref checks returned no retraction or expression-of-concern flag for those three. NICE CG61 was re-read and still reports review on 30 April 2025 and no planned clinical-management update. Argentine recommendations are not synthesized from the abstract. The German correction uses DOI metadata and the society's version page; the Canadian full text was opened. Date-restricted PubMed guideline and Europe PMC searches found no new comprehensive IBS society guideline warranting a further row; CENTRAL was not searched.
2026-10-21 provenance. No new catalogue row. NICE CG61 was re-read and still reports last reviewed 30 April 2025 with no planned clinical-management update. Date-restricted PubMed (guideline[pt] / consensus / position paper) and Europe PMC guideline queries in 2026-10-14–2026-10-21 returned no new comprehensive IBS society guideline. The German S3 successor remains in progress on the DGVS page; no posted CAG successor. CENTRAL was not searched.