Assessing Treatment Response in Patients With IBS-C in Clinical Practice: Consensus Expert Recommendations Using a Modified Delphi Process
Gregory S. Sayuk, Dina Filipenko, Klaudia Kornalska, Paul Swinburn, Lin ChangINTRODUCTION:
Irritable bowel syndrome with constipation (IBS-C) is a common disorder of gut–brain interaction, characterized by constipation and abdominal symptoms that negatively affect health-related quality of life (HRQoL). Best practices for adjusting treatments based on patient response remain undefined, leading to inconsistent clinical management. This study aimed to establish expert consensus on assessing therapeutic response and guiding treatment decisions in IBS-C using a modified Delphi process.
METHODS:
A 2-round Delphi panel was conducted with US-based health care professionals experienced in IBS-C. Sixteen statements addressing symptom assessment, treatment response, HRQoL, treatment side effects, patient satisfaction, and treatment decisions were rated on a 5-point Likert scale. Consensus was defined as ≥80% agreement. Statements not reaching consensus after round 1 were revised/excluded; 9 statements were rerated in round 2.
RESULTS:
Fourteen statements reached consensus. Key points for treatment-response assessment included integrating evaluations of bowel and abdominal symptoms. Recommendations highlight the value of assessing the severity of the most bothersome symptoms before treatment, impact on HRQoL, and patient satisfaction with the treatment. Although standardized measures in clinical settings were desired for treatment-response assessment, none were consistently recommended by the panelists. Other key factors influencing treatment decisions included balancing benefits against side effects, patient preferences and expectations, clinician familiarity with therapies, and shared decision-making.
CONCLUSIONS:
The consensus recommendations highlight the importance of comprehensive, patient-centered evaluation of therapeutic response in IBS-C and underscore the need for practical, standardized tools to guide individualized treatment decisions to improve outcomes and reduce variability in IBS-C management.