Management of Irritable Bowel Syndrome (IBS) Clinical Practice Guidelines (BSG, 2021)

British Society of Gastroenterology (BSG)

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

August 06, 2021

Guidelines for the management of patients with irritable bowel syndrome (IBS) were published in July 2021 by the British Society of Gastroenterology (BSG) in Gut.[1]

Fiber and Dietary Therapies

Food elimination diets based on immunoglobulin G (IgG) antibodies are not recommended, nor are gluten-free diets.

Soluble fiber is effective for global symptoms and abdominal pain, but insoluble fiber should be avoided.

A diet low in fermentable oligosaccharides, disaccharides, and monosaccharides and polyols is effective second-line therapy for global symptoms and abdominal pain.


Probiotics may be effective for global symptoms and abdominal pain, but no specific species or strain can be recommended.

First-Line Drugs for IBS

Loperamide may be effective for diarrhea. Peppermint oil and certain antispasmodics may be effective for global symptoms and abdominal pain. Polyethylene glycol may be effective for constipation.

Gut-Brain Neuromodulators

Tricyclic antidepressants (TCAs) used as gut-brain neuromodulators are effective second-line treatment for global symptoms and abdominal pain. Selective serotonin reuptake inhibitors (SSRIs) used as gut-brain neuromodulators may be effective second-line treatment for global symptoms.

Second-Line Drugs in Secondary Care

Eluxadoline, 5-hydroxytryptamine 3 (5-HT3) receptor antagonists, and rifaximin are efficacious second-line drugs for IBS with diarrhea (IBS-D) in secondary care. Linaclotide, lubiprostone, plecanatide, tenapanor, and tegaserod are efficacious second-line agents for IBS with constipation (IBS-C) in secondary care.

Psychological Therapies

IBS-specific cognitive behavioral therapy (CBT) and gut-directed hypnotherapy may be efficacious for global symptoms.

Severe or Refractory Symptoms

Severe or refractory IBS should be managed with an integrated multidisciplinary approach, with care taken to avoid iatrogenic harms.

Combination gut-brain neuromodulators (augmentation) may be considered for more severe symptoms.

For more information, please go to Irritable Bowel Syndrome (IBS).


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