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.