British Society of Gastroenterology guidelines on the management of irritable bowel syndrome

Dipesh H Vasant1,2, Peter A Paine2

Rona Moss-Morris
Abstract
Irritable bowel syndrome (IBS) remains one of the most common gastrointestinal disorders seen by clinicians in both primary and secondary care. Since publication of the last British Society of Gastroenterology (BSG) guideline in 2007, substantial advances have been made in understanding its complex pathophysiology, resulting in its re-classification as a disorder of gut-brain interaction, rather than a functional gastrointestinal disorder. Moreover, there has been a considerable amount of new evidence published concerning the diagnosis, investigation and management of IBS. The primary aim of this guideline, commissioned by the BSG, is to review and summarise the current evidence to inform and guide clinical practice, by providing a practical framework for evidence-based management of patients. One of the strengths of this guideline is that the recommendations for treatment are based on evidence derived from a comprehensive search of the medical literature, which was used to inform an update of a series of trial-based and network meta-analyses assessing the efficacy of dietary, pharmacological and psychological therapies in treating IBS. Specific recommendations have been made according to the Grading of Recommendations Assessment, Development and Evaluation system, summarising both the strength of the recommendations and the overall quality of evidence. Finally, this guideline identifies novel treatments that are in development, as well as highlighting areas of unmet need for future research.

https://gut.bmj.com/content/70/7/1214

 

There are an awful lot of references to "recommendation: strong, quality of evidence: low" in that paper, as well as quite a few references to "recommendation: strong, quality of evidence: weak".

I am sure there is some logic to describing recommendations as strong while describing the quality of evidence as low or weak, but being a non-scientist it totally escapes me.

 

Specifically, all 3 recommendations for psychological stuff are rated low, although despite having low evidence, CBT is recommended strongly. How in the hell did this seriously pass? Completely different standards: some and none.

It's "good evidence" despite being rated above as low evidence. Do words even matter? Does evidence not actually matter in EBM? Seems so.

Almost everything is low or weak quality. And despite being low quality evidence, CBT is somehow strongly recommended, because talk is cheap. If anything this is a recognition that the psychobehavioral model has failed, yet it still recommends it because, I guess, it's too hard to do real work? As if the reframing of "gut-brain axis" means anything different from "functional". They genuinely cannot think of the impact of making stuff up in a professional capacity, are completely insulated from reality.

I'm sorry but this is what no progress looks like. And still they present this stagnation as "substantial advances". What substantial advances? Or even trivial advances? They got nothing, are completely stuck because of all the years wasted on BPS stuff that they can't bring themselves to admit is a failure because of how gung-ho it's been pushed, without any evidence to boot.