The AGA Quality Committee, in collaboration with the Rome Foundation, has released quality indicators for irritable bowel syndrome (IBS), published in the March issue of Gastroenterology.
After reviewing national and international society guidelines and consensus statements on the epidemiology, diagnosis, and management of IBS, the committee developed nine quality indicators. These are evidence-based best practices to guide your patient care.
Quality indicators for IBS evaluation and diagnosis
- Obtaining a detailed patient history, performing a physical examination, and providing clear communication of diagnosis to patients, including education and reassurance.
- Testing for celiac disease (ie, tissue transglutaminase IgA) in patients with IBS-D or IBS-M with an alternate test (ie, tissue transglutaminase IgG or deamidated gliadin peptide IgG) for those with IgA deficiency.
- Evaluation with fecal calprotectin (FCP) in individuals with IBS-D.
- Avoidance of routine colonoscopy in patients with IBS who do not otherwise meet criteria for CRC screening and do not have alarm features.
Quality indicators for IBS management
- Treatment with alosetron, eluxadoline, rifaximin, or tricyclic antidepressants (TCAs) should be considered in patients with IBS-D.
- Treatment with linaclotide, lubiprostone, plecanatide, tenapanor, or TCAs should be considered in patients with IBS-C.
- Avoidance of centrally acting opioids for IBS-related pain.
- Recognition of the brain–gut axis and performance or referral for brain–gut behavior therapies, such as cognitive behavioral therapy or gut-directed hypnotherapy.
- Dietary counseling (eg, increased soluble fiber or low fermentable oligo-, di-, mono-saccharide and polyol [FODMAP] diet) or referral to a dietitian.
Implementation remarks:
- Alosetron is approved for women with severe IBS-D who do not respond to conventional therapy.
- Eluxadoline is contraindicated in patients without gallbladders or those who drink more than 3 alcoholic beverages per day or have a history of pancreatitis.
- Choice of therapy will depend on availability, cost, and other factors. Some medications may not be approved or available in certain countries.
For further information on how to implement these quality indicators in practice, read the full publication in Gastroenterology.
Tell me more about quality indicators …
Quality indicators are statements derived from published guidelines and consensus documents that describe appropriate care related to a disease state, from diagnosis to management. Quality indicators provide a framework for providing evidence-based, guideline-supported care and can be used at an individual- or practice-level to measure high-quality care and reduce variations in care. Learn more.
