Assessing Treatment Response in Patients With IBS-C in Clinical Practice: Consensus Expert Recommendations Using a Modified Delphi Process: GI Signals

Motility guideline · Aug 19, 2026 · Clin Transl Gastro · IF 3.4

Assessing Treatment Response in Patients With IBS-C in Clinical Practice: Consensus Expert Recommendations Using a Modified Delphi Process.

Guideline / reviewIBSguideline

Clinical takeawaySystematize IBS-C treatment response assessment using expert consensus domains: before starting treatment, establish baseline severity of the patient's most bothersome symptom(s) and quality-of-life impact; at follow-up, reassess these domains alongside patient satisfaction and side effects to inform shared decision-making on treatment continuation or adjustment. However, no validated standardized measure is yet available; assessment relies on clinical judgment.

What it foundModified Delphi process with US IBS-C experts reached consensus (≥80% agreement) on 14 statements defining treatment-response assessment domains: severity of most bothersome symptoms, impact on health-related quality of life, patient satisfaction with treatment, and side effects. No standardized measure was consistently endorsed by panelists.

ContextAddresses previously undefined best practice in IBS-C management, where treatment-response assessment and adjustment strategies were inconsistent across practices. Formalizes and codifies a patient-centered, multi-domain approach that reflects evolving emphasis on shared decision-making and quality-of-life outcomes in functional GI disorders.

Emergingsuggested applicable standard· American College of Gastroenterology, 'ACG Clinical Guideline: Management of Irritable Bowel Syndrome', 2021

Decision at stakehow to systematically assess therapeutic response and guide treatment adjustments in IBS-C

… IBS-C: chloride channel activators (strong, moderate) and guanylate cyclase activators (strong, high); AGAINST PEG products for global IBS-C symptoms (conditional, low); tegaserod reserved for women younger than 65 with ≤1 cardiovascular risk factor who have not adequately responded to secretagogues (strong/conditional, low). …

From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text. The rest of this standard includes IBS-D.

Our full summary of this standard

Diagnosis: use a positive diagnostic strategy based on Rome IV criteria rather than a strategy of exclusion (strong for cost-effectiveness, high quality; consensus for time-to-therapy), and categorize by IBS subtype (consensus). In patients with IBS and diarrhea symptoms: check celiac serology (strong, moderate) and, in those WITHOUT alarm features, fecal calprotectin (or fecal lactoferrin) plus CRP to rule out IBD (strong; moderate quality for CRP/calprotectin, very low for lactoferrin). Recommend AGAINST routine stool testing for enteric pathogens (conditional, low) and AGAINST routine colonoscopy in patients younger than 45 without warning signs (conditional, low). Anorectal physiology testing only when symptoms suggest a pelvic floor disorder and/or for refractory constipation not responding to standard medical therapy (consensus). Treatment, all subtypes: soluble, not insoluble, fiber (strong, moderate); a LIMITED trial of a low-FODMAP diet (conditional, very low); gut-directed psychotherapies for global symptoms (conditional, very low); TCAs for global symptoms (strong, moderate); peppermint suggested (conditional, low); antispasmodics for abdominal pain (conditional, low); AGAINST probiotics (conditional, very low), AGAINST fecal transplant (strong, very low). IBS-C: chloride channel activators (strong, moderate) and guanylate cyclase activators (strong, high); AGAINST PEG products for global IBS-C symptoms (conditional, low); tegaserod reserved for women younger than 65 with ≤1 cardiovascular risk factor who have not adequately responded to secretagogues (strong/conditional, low). IBS-D: rifaximin (strong, moderate); alosetron only for women with severe IBS-D who have failed conventional therapy (conditional, low); mixed opioid agonists/antagonists, i.e. eluxadoline (conditional, moderate); AGAINST bile acid sequestrants (conditional, very low).

American College of Gastroenterology, 'ACG Clinical Guideline: Management of Irritable Bowel Syndrome', 2021 · reviewed 2026-07-21 ↗

Sayuk GS … Chang L · Clinical and Translational Gastroenterology · IF 3.4 · PubMed ↗Permalink