Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder that affects approximately one in 10 individuals in North America. IBS imposes a significant burden on the health care system and reduces quality of life. Recently, both the Canadian Association of Gastroenterology (CAG) and the American College of Gastroenterology (ACG) updated their clinical practice guidelines for the management of IBS. Guidelines are based on evidence in the literature and consensus discussion by group members at a meeting, usually made up of experts in the area of IBS. The ACG Task Force was made up predominantly of academic gastroenterologist while the CAG Consensus Group included academic gastroenterologists, general practitioners, psychiatrists, and psychologists. Furthermore, with CAG’s recent partnership with the IMAGINE Network, the CAG Consensus Group also included a patient representative. The patient representative was a full participant throughout the clinical guidelines development process – contributing to the pre-voting process and the group discussion.
A comparison between the two sets of guidelines revealed some differences. Both sets of guidelines used the GRADE system to evaluate the quality of the scientific evidence available and both had one methodologist in common (PM) and were presented with the same data to interpret. There were similarities in conclusions for many statements but there were some instances the groups reached different treatment recommendations for patients with IBS. In particular, the Canadian IBS guidelines were broader in scope, including recommendations on diagnostic testing and alternative therapies for IBS. Both guidelines evaluated many of the same pharmacological interventions for IBS but again differences were found. For example, the US guidelines gave a strong recommendation for lubiprostone whilst the Canadian guideline gave this drug a conditional recommendation. Furthermore, while the American guidelines suggested the use the non-absorbable antibiotic rifaximin for reduction in global IBS symptoms as well as bloating in non-constipated IBS patients, the Canadian consensus group chose not make a recommendation (neither for nor against) offering diarrhea-predominant IBS patients one course of rifaximin therapy to improve IBS symptoms. Input from primary doctors and the patient representative was a major factor in these differing interpretations of the data. Therefore, the composition of a more diverse group of healthcare professionals and the inclusion of the patient’s perspective within the Canadian consensus group is likely to have influenced the final product.
Clinical practice guidelines are important to healthcare professionals and patients, and are critical to advancing patient outcomes. Once the Canadian guidelines are published in a scientific journal they will be communicated to clinicians treating IBS patients. IMAGINE will work closely with CAG and patient advocacy groups to build an awareness campaign to disseminate this information to a broader group of key stakeholders (including patients and policy makers). The importance of the patient/physician relationship is paramount when making decisions regarding treatment plans, which, in turn, impacts the likelihood of adherence to the treatment plan. It is therefore expected that with greater uptake of these guidelines, patient outcomes will improve ultimately resulting in cost savings to the healthcare system.