brand logo

Am Fam Physician. 2022;105(6):online

Clinical Question

What is the best way to manage irritable bowel syndrome (IBS)?

Bottom Line

This high-quality evidence-based guideline provides sound advice for the evaluation and management of IBS in primary care. (Level of Evidence = 1a)


The guidelines from the British Society of Gastroenterology were created by a multidisciplinary panel that included primary care physicians, psychologists, dietitians, and gastroenterologists. Treatment recommendations were based on systematic reviews, and other recommendations were based on a comprehensive review of the literature. There are dozens of recommendations; this POEM outlines the highlights. The guidelines advocate a pragmatic definition of IBS as at least six months of abdominal pain or discomfort with altered bowel habits, and the absence of alarm signs or symptoms. Initial evaluation in primary care should include a complete blood count, C-reactive protein or sedimentation rate, and serology for celiac disease. For patients younger than 45 years who present with diarrhea, order a fecal calprotectin test to rule out inflammatory bowel disease. 

Screen for colorectal cancer in accordance with national guidelines; colonoscopy is only recommended for patients with alarm signs and symptoms or who are at increased risk of microscopic colitis (women; patients 50 years and older; those with comorbid autoimmune disease, weight loss, diarrhea for less than 12 months, or nocturnal or severe, watery diarrhea). Consider testing for bile acid diarrhea in patients with nocturnal diarrhea or prior cholecystectomy. The guidelines recommend against testing for pancreatic insufficiency, small intestinal bacterial overgrowth, or carbohydrate intolerance if the symptoms are typical for IBS. 

Already a member/subscriber?  Log In


From $165
  • Immediate, unlimited access to all AFP content
  • More than 130 CME credits/year
  • AAFP app access
  • Print delivery available

Issue Access

  • Immediate, unlimited access to this issue's content
  • CME credits
  • AAFP app access
  • Print delivery available
Purchase Access:  Learn More

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to

This series is coordinated by Natasha J. Pyzocha, DO, contributing editor.

A collection of POEMs published in AFP is available at

Continue Reading

More in AFP

More in Pubmed

Copyright © 2022 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.