In the September 24, 2001, issue of the ARCHIVES, Dr Fass and colleagues1 presented a state-of-the-art review on the evaluation and treatment of irritable bowel syndrome (IBS). The authors performed a thorough literature review and, using an evidence-based approach, presented an algorithm on the evaluation and management of patients with IBS.
I would like to alert the readers of this journal to new information regarding the management of IBS that has emerged since the publication of that review. In November 2002, the American College of Gastroenterology published an evidence-based position statement on the utility of diagnostic studies in the evaluation of IBS.2,3 This position statement also included thoughtful recommendations regarding currently available medications for the treatment of IBS. Clinical trials of IBS therapies were reviewed, and a quantitative assessment of study methodology was conducted. In addition, IBS therapies were assessed for their ability to provide global relief of IBS symptoms. Only 2 medications were given the highest recommendation (grade A rating): tegaserod for the treatment of IBS with constipation and alosetron hydrochloride for the treatment of IBS with diarrhea. No other agents (including antispasmodics, bulking agents, antidiarrheals [loperamide], and antidepressants) were found to have met the criteria for high-quality trials or to provide global relief of IBS symptoms.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
The Rational Clinical Examination
Make the Diagnosis: Irritable Bowel Syndrome
The Rational Clinical Examination
Original Article: Will the History and Physical Examination Help Establish That Irritable Bowel Syndrome Is Causing This Patient's Lower Gastrointestinal Tract Symptoms?
All results at
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.