Home » AGEB Journal » Issues » Volume 85" » Fasc.2 - Guidelines » Article details

Belgian consensus on irritable bowel syndrome

Journal Volume 85 - 2022
Issue Fasc.2 - Guidelines
Author(s) S. Kindt 1, H. Louis 2, H. De Schepper 3, J. Arts 4 5, P. Caenepeel 4 6 7, D. De Looze 8, A. Gerkens 9, T. Holvoet 8 10, P. Latour 11, T. Mahler 12, F. Mokaddem 13, S. Nullens 3, H. Piessevaux 14, P. Poortmans 1, G. Rasschaert 1, M. Surmont 1, H. Vafa 15, K. Van Malderen 3, T. Vanuytsel 4, F. Wuestenberghs 16, J. Tack 4
Full article
Full Article
PAGES 360-382
(1) Department of gastroenterology and Hepatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussel, Belgium
(2) Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium
(3) Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium
(4) Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
(5) Department of Gastroenterology, AZ Sint-Lucas, Brugge, Belgium
(6) Department of Gastroenterology, Ziekenhuis Oost-Limburg, Campus Sint-Jan, Genk, Belgium
(7) UHasselt, Hasselt, Belgium
(8) Department of Gastroenterology and Hepatology, University Hospital Ghent, Gent, Belgium
(9) Boitsfort Medical Center, Brussels, Belgium
(10) Department of Gastroenterology, AZ Nikolaas, Sint Niklaas, Belgium
(11) Department of Gastroenterology, Hepatology and Digestive Oncology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
(12) Department of Pediatrics, Universitair Ziekenuis Brussel, Brussel, Belgium
(13) Department of Gastroenterology and Hepatology, Vivalia-Centre Sud Luxembourg, Arlon, Belgium
(14) Department of Hepato-gastroenterology, Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium
(15) Department of Gastroenterology and Hepatology, Chirec-Site Delta, Brussels, Belgium
(16) Department of Gastroenterology and Hepatology, CHU UCL Namur, Université catholique de Louvain, Yvoir, Belgium

Background: Irritable bowel syndrome (IBS) is characterised by recurrent abdominal pain related to defaecation or associated with altered stool frequency or consistency. Despite its prevalence, major uncertainties in the diagnostic and therapeutic management persist in clinical practice.

Methods: A Delphi consensus was conducted by 20 experts from Belgium, and consisted of literature review and voting process on 78 statements. Grading of recommendations, assessment, development and evaluation criteria were applied to evaluate the quality of evidence. Consensus was defined as > 80 % agreement.

Results: Consensus was reached for 50 statements. The Belgian consensus agreed as to the multifactorial aetiology of IBS. According to the consensus abdominal discomfort also represents a cardinal symptom, while bloating and abdominal distension often coexist. IBS needs subtyping based on stool pattern. The importance of a positive diagnosis, relying on history and clinical examination is underlined, while additional testing should remain limited, except when alarm features are present. Explanation of IBS represents a crucial part of patient management. Lifestyle modification, spasmolytics and water-solube fibres are considered first-line agents. The low FODMAP diet, selected probiotics, cognitive behavioural therapy and specific treatments targeting diarrhoea and constipation are considered appropriate. There is a consensus to restrict faecal microbiota transplantation and gluten- free diet, while other treatments are strongly discouraged.

Conclusions: A panel of Belgian gastroenterologists summarised the current evidence on the aetiology, symptoms, diagnosis and treatment of IBS with attention for the specificities of the Belgian healthcare system.

Keywords: irritable bowel syndrome, delphi consensus, diagnosis, treatment, review.

© Acta Gastro-Enterologica Belgica.
PMID 35709780