Irritable Bowel Syndrome

Strength of Recommendation and Quality of Evidence Strength of Recommendation 1 – strong 2 – weak Quality of Evidence A – high B – moderate C – low or very low Grade 1A 1B 1C 2A 2B 2C Benefits clearly outweigh risk and burdens, or vice versa Benefits closely balanced with risks and burden Methodological Quality of Supporting Evidence RCTs without important limitations or overwhelming evidence from observational studies RCTs with important limitations or exceptionally strong evidence from observational studies Observational studies or case series Implications Can apply to most patients in most circumstances. Further evidence is unlikely to change confidence in the estimate of effect. Can apply to most patients in most circumstances. Higher quality evidence may well change the strength of the recommendation. Can apply to most patients in most circumstances. Higher quality evidence is very likely to change confidence in the estimate of effect. Best action may differ depending on circumstances or patients' or societal values. Further evidence is unlikely to change confidence in the estimate of effect. Best action may differ depending on circumstances or patients' or societal values. Higher quality evidence may well change the strength of the recommendation. Other alternatives may be equally reasonable. Higher quality evidence is likely to change confidence in the estimate of effect. Source American College of Gastroenterology Task Force on Irritable Bowel Syndrome, Brandt LJ, Chey WD, Foxx-Orenstein AE, Schiller LR, Schoenfeld PS, Spiegel BM, Talley NJ, Quigley EM. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol. 2009 Jan;104 Suppl 1:S1-35. PMID: 19521341 Khan S, Chang L. Diagnosis and management of IBS. Nat Rev Gastroenterol Hepatol. 2010 Oct;7(10):565-581. PMID: 20890316 Mayer EA. Clinical practice. Irritable bowel syndrome. N Engl J Med. 2008 Apr 17; 358(16):1692-1699. PMID: 18420501 Disclaimer This Guideline attempts to define principles of practice that should produce high-quality patient care. It focuses on the needs of primary care practice, but also is applicable to providers at all levels. This Guideline should not be considered exclusive of other methods of care reasonably directed at obtaining the same results. The ultimate judgment concerning the propriety of any course of conduct must be made by the clinician aſter consideration of each individual patient situation. Neither IGC, ANMS, nor the authors endorse any product or service associated with the distributor of this clinical reference tool. IBS051221 5740 Executive Drive Suite 218 Baltimore, MD 21228 TEL: 410-869-3332 • FAX: 410-744-2150 For additional copies: orders@GuidelineCentral.com Copyright © 2012 All rights reserved

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