This updated systematic review and meta-analysis aimed to assess the effectiveness of antidepressants and psychological therapies in treating irritable bowel syndrome (IBS). The analysis included 53 randomized controlled trials that compared antidepressants with placebo, and psychological therapies with control therapy or usual management. The results showed that antidepressants significantly reduced IBS symptoms, with a relative risk (RR) of 0.66 for symptoms not improving compared to placebo. Both tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) were found to be effective, although there was some heterogeneity among SSRIs trials. Psychological therapies, including cognitive behavioral therapy and hypnotherapy, also showed positive effects, with an RR of 0.69 for symptoms not improving, though there was significant variability between studies.

While both antidepressants and psychological therapies were found to be effective in reducing IBS symptoms, the quality of evidence for psychological therapies was limited, and treatment effects might have been overestimated due to issues with trial design, such as lack of blinding. The study concludes that antidepressants are an efficacious treatment for IBS, and psychological therapies can also be beneficial, but further high-quality trials are needed to confirm their true efficacy and optimize treatment approaches.

Reference: Ford AC, Lacy BE, Harris LA, et al. Effect of Antidepressants and Psychological Therapies in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-Analysis. Am J Gastroenterol. 2019 Jan;114(1):21-39. doi: 10.1038/s41395-018-0222-5. PMID: 30177784.

A multicenter, double-blind, placebo-controlled trial was conducted to determine if amitriptyline (10-30 mg nightly) is superior to placebo for improving irritable bowel syndrome (IBS) symptoms over 6 months in the primary care setting. The study included 463 patients who met the Rome IV criteria for IBS, with a baseline IBS-Symptom Severity Score (IBS-SSS) greater than 75. Patients were randomized to receive amitriptyline or a placebo, with the option to titrate the dose based on symptom improvement. The primary outcome was the change in IBS-SSS after 6 months, with a secondary outcome assessing global relief of IBS symptoms.

Results showed that amitriptyline significantly improved IBS symptoms, with the IBS-SSS score decreasing by an average of 27 points compared to 8 points for the placebo group (P = 0.008). Amitriptyline-treated patients were also more likely to report relief of IBS symptoms (odds ratio 1.78 for some relief, 1.88 for considerable/complete relief). Adverse events, primarily due to the drug’s anticholinergic effects, occurred more frequently in the amitriptyline group, with dry mouth, drowsiness, and blurred vision being the most common. Despite these side effects, amitriptyline was found to be effective in improving IBS symptoms in the primary care setting.

Reference: Schoenfeld P. Low-dose Tricyclic Antidepressants for Irritable Bowel Syndrome: Definitive Evidence of Benefit from ATLANTIS. American College of Gastroenterology. Published December 12, 2023. Accessed February 7, 2025. https://gi.org/journals-publications/ebgi/schoenfeld_dec2023/

This randomized controlled trial investigated the effectiveness of linaclotide compared to placebo in reducing abdominal symptoms (bloating, discomfort, pain) in IBS-C patients using a patient-reported outcome tool (DIBSS-C). The study involved 614 patients across 78 U.S. centers, demonstrating that linaclotide significantly improved abdominal symptoms compared to placebo, with greater reductions in overall abdominal scores (-1.9 vs -1.2) and higher responder rates (40.5% vs 23.4%). Diarrhea-related discontinuation rates were low (1.6%), and symptom improvement persisted unless the medication was withdrawn.

The study supports linaclotide as a superior treatment option for IBS-C, particularly in addressing challenging abdominal symptoms not effectively relieved by osmotic laxatives. The authors emphasize realistic expectations—patients may require up to 12 weeks to see maximal benefit, and complete symptom resolution is uncommon. They recommend using linaclotide as part of a multimodal approach, combining it with dietary modifications, complementary therapies, or neuromodulators for optimal patient outcomes.

Reference: Deutsch J, Schoenfeld P. Treating All the Symptoms of IBS-C: Linaclotide Significantly Decreases Abdominal Pain, Bloating, and Discomfort. American College of Gastroenterology. Published January 13, 2022. Accessed April 14, 2025. https://gi.org/journals-publications/ebgi/treating-all-the-symptoms-of-ibs-c/

Digital health is reshaping irritable bowel syndrome (IBS) care from diagnosis to day-to-day management. Noninvasive “smart” capsules and bacterial detection systems sample intestinal contents and physiology, while machine-learning models analyze microbiome, stool biomarkers, and patient-reported data to distinguish IBS subtypes and rule out organic disease. Wearables and apps (eg, watches, bands, patches) track heart rate variability, activity, stress, and symptoms, link triggers (diet, sleep, stress) to flares, and support adherence with tools like FODMAP guidance. mHealth platforms deliver cognitive behavioral therapy, mindfulness, and just-in-time adaptive interventions. Artificial intelligence (AI) agents (eg, emotion-aware chatbots) personalize prompts and integrate real-time data for remote care. These capabilities are increasingly integrated into telemedicine workflows, enabling longitudinal monitoring between visits and more timely, data-informed adjustments.

These tools are associated with fewer symptoms, better quality of life, higher adherence, and reduced unnecessary testing and visits, but face hurdles: variable data quality, privacy/security concerns, digital access gaps, and uneven reliability of non-validated AI advice. Looking ahead, AI may enable earlier diagnosis from microbiome signals, electronic medical record-integrated decision support that fuses wearable and patient-reported data, virtual reality-based therapies for gut–brain modulation, and reinforcement-learning protocols that adapt treatments over time—shifting IBS care toward proactive, precision-guided management.

Reference: De Silva AP, Prabagar K, Niriella MA, De Silva HJ. Management of Irritable Bowel Syndrome: The Role of Digital Health Technologies. J Gastrointestin Liver Dis. 2025;34(3):275-278. doi: 10.15403/jgld-6189.

This 2025 review explores how gut microbiota imbalance (dysbiosis) may contribute to the development and persistence of irritable bowel syndrome (IBS). Patients with IBS often demonstrate reduced microbial diversity and compositional changes in key bacterial taxa, along with altered production of metabolites such as short-chain fatty acids (SCFAs), bile acids, and tryptophan derivatives. These microbial and metabolic changes are associated with low-grade inflammation, impaired epithelial barrier function, abnormal motility patterns, and amplified pain signaling. However, findings remain heterogeneous, and no single, reproducible “IBS microbiome signature” has been consistently identified across studies.

The review highlights probiotics and probiotic-derived metabolites (postbiotics) as potential adjunctive therapeutic strategies aimed at restoring microbial balance and targeting underlying IBS mechanisms. Specific strains—particularly selected Bifidobacterium and Lactobacillus species—may improve symptoms through multiple pathways, including strengthening epithelial barrier integrity, reducing pro-inflammatory signaling, modulating immune and enteric nervous system activity, and influencing bile acid metabolism and SCFA production. Some data suggest strain-specific benefits for bloating, abdominal pain, and stool patterns, though effects vary by IBS subtype. While early results are encouraging, questions remain regarding optimal strain selection, dosing strategies, treatment duration, patient selection, and long-term safety. Larger, well-controlled clinical trials are needed to clarify efficacy and guide routine integration into clinical practice.

Reference: García Mansilla MJ, Rodríguez Sojo MJ, Lista AR, et al. Exploring Gut Microbiota Imbalance in Irritable Bowel Syndrome: Potential Therapeutic Effects of Probiotics and Their Metabolites. Nutrients. 2024 Dec 31;17(1):155. doi: 10.3390/nu17010155. PMID: 39796588; PMCID: PMC11723002.

Authors of this systematic review (2000–2024) evaluated clinical evidence for invasive and noninvasive electrical neuromodulation in irritable bowel syndrome (IBS), assessed study quality, and summarized mechanisms, side effects, and cost considerations. Invasive options—sacral nerve stimulation (SNS) and spinal cord stimulation—showed benefits for pain and quality of life (QoL) in highly selected patients, mainly IBS with diarrhea/IBS with a mixed bowel pattern. Crossover randomized controlled trials (RCTs) and follow-ups reported reduced symptom scores, fewer bowel movements, and durable QoL gains, alongside device-related adverse events (implant-site pain, lead revisions) but no life-threatening harms. Modeling suggests SNS can be cost-effective long-term.

Noninvasive approaches target the vagal/brain–gut axis with favorable safety and self-use potential. Transcutaneous auricular VNS (taVNS) improved abdominal pain, constipation, rectal sensitivity, and mood in IBS with contsipation RCTs; percutaneous auricular nerve field stimulation (PENFS) reduced pain and disability in adolescents, with exploratory microbiome shifts; and transcutaneous electrical acustimulation (TEA) improved pain, constipation, transit, and QoL in small RCTs. PENFS requires clinician placement, while taVNS/TEA are home-friendly. Overall, neuromodulation—especially taVNS, PENFS, and TEA—appears promising for IBS pain and, in IBS-C, for constipation, warranting multicenter trials to refine candidates, dosing, durability, and cost-effectiveness.

Reference: Wang K, Alam MJ, Lan X, Li F, Chen JDZ. Efficacy and mechanisms of neuromodulation in the treatment of irritable bowel syndrome. Bioelectron Med. 2025;11(1):23. doi: 10.1186/s42234-025-00186-5.

A community-based study in Birmingham, UK, found that IBS affects 10.5% of the population, with a higher prevalence in women aged 15-45. The condition leads to a significant healthcare burden due to frequent medical visits, even for non-gastrointestinal symptoms. IBS is influenced by various factors, including psychological stress, food intolerances, genetic predispositions, and gut motility issues. The pathophysiology is thought to involve visceral hypersensitivity and dysregulation of the central nervous system.

Management of IBS includes both non-pharmacological strategies like diet and psychotherapy and pharmacological treatments, such as antidepressants, bulking agents, and antispasmodics. Tricyclic antidepressants (TCAs) have been shown to improve IBS symptoms by altering pain perception and regulating gastrointestinal function. A meta-analysis of trials found that TCAs significantly reduced abdominal pain and improved clinical responses in patients with IBS, although side effects may limit their use. TCAs are particularly beneficial for moderate to severe cases, with dosing tailored to individual patient needs. Further research is required to refine their role in IBS treatment and compare their efficacy with other antidepressant classes.

Reference: Rahimi R, Nikfar S, Rezaie A, et al. Efficacy of tricyclic antidepressants in irritable bowel syndrome: a meta-analysis. World J Gastroenterol. 2009 Apr 7;15(13):1548-53. doi: 10.3748/wjg.15.1548. PMID: 19340896; PMCID: PMC2669938.

The study evaluated whether IBS subtype affects IBS-specific quality of life (QOL) in patients seen at a US tertiary-care functional GI disorders clinic. IBS and subtype were identified using the Rome III questionnaire, and QOL was measured with the IBS-QOL tool (0–100 scale; higher = better QOL) across eight domains: dysphoria, activity interference, body image, health worry, food avoidance, social reactions, sexual health, and relationships. Researchers compared overall and subscale scores across subtypes using ANOVA, while controlling for age and gender, with Bonferroni-adjusted post-hoc testing when appropriate.

Among 243 Rome III–confirmed patients with IBS (most commonly IBS-M at ~50%, followed by IBS-D ~23%, IBS-C ~22%, and IBS-U ~5%), overall QOL differed significantly by subtype (P=0.01). Patients with IBS-D and IBS-M had significantly lower overall IBS-QOL than those with IBS-C (IBS-D ~61.6; IBS-M ~63.0 vs IBS-C ~74.5). Compared with IBS-C, IBS-D scored worse for food avoidance and interference with activities, while IBS-M showed greater activity interference and relationship impact, and worse food avoidance and social reaction scores. The authors conclude that IBS-D and IBS-M are associated with poorer IBS-specific QOL than IBS-C, particularly around food avoidance, daily functioning, and relationships—areas clinicians should proactively assess and address.

Reference: Singh P, Staller K, Barshop K, et al. Patients with irritable bowel syndrome-diarrhea have lower disease-specific quality of life than irritable bowel syndrome-constipation. World J Gastroenterol. 2015 Jul 14;21(26):8103-9. doi: 10.3748/wjg.v21.i26.8103. PMID: 26185382; PMCID: PMC4499353.

A survey of United States gastroenterologists explored their perceptions of dietary therapies for managing irritable bowel syndrome (IBS). The survey, which gathered responses from 1,562 gastroenterologists, found that nearly 60% of providers noted patients commonly associate food with gastrointestinal (GI) symptoms. Most patients with IBS use a trial-and-error approach to diet, with many trying lactose-free and gluten-free diets, though few independently follow a low FODMAP diet. Over half of the gastroenterologists recommend dietary therapy to more than 75% of their IBS patients, with the low FODMAP diet being the most suggested. However, only 21% of providers regularly refer patients to registered dietitians, and only 30% use GI dietitians.

The survey highlighted a general enthusiasm among gastroenterologists for using dietary therapies to manage IBS, particularly the low FODMAP diet, even though patients rarely try it independently. However, referral rates to dietitians, especially those with GI training, remain low. Female providers were found to be more likely to recommend dietary changes as the primary mode of therapy compared to their male counterparts. The results suggest that while dietary approaches are widely accepted, greater collaboration with specialized dietitians may be needed to optimize patient care.

Reference: Lenhart A, Ferch C, Shaw M, et al. Use of Dietary Management in Irritable Bowel Syndrome: Results of a Survey of Over 1500 United States Gastroenterologists. J Neurogastroenterol Motil. 2018 Jul 30;24(3):437-451. doi: 10.5056/jnm17116. PMID: 29886578; PMCID: PMC6034671.

This nationwide, population-based study used data from the National GI Survey to evaluate abdominal pain characteristics across irritable bowel syndrome (IBS) subtypes using the validated GI-PROMIS instrument. Of the 71,812 survey participants, 1,158 met modified Rome III criteria for IBS and reported abdominal pain within the past 7 days. These participants were stratified into IBS with diarrhea (IBS-D), IBS with constipation (IBS-C), and IBS with mixed bowel habits (IBS-M) groups. Compared to IBS-D, individuals with IBS-C reported significantly more bothersome, frequent, and interfering abdominal pain. IBS-C and IBS-M also showed more diffuse pain patterns and involvement of a greater number of abdominal regions. IBS-C had the highest composite GI-PROMIS scores, indicating greater pain burden.

The study highlights that abdominal pain manifests differently across IBS subtypes, with patients with IBS-C experiencing the most severe and diffuse symptoms. These differences may reflect distinct underlying mechanisms, including variations in visceral hypersensitivity and neural pain processing. The findings suggest that abdominal and bowel symptoms differ not only in frequency but in qualitative experience across subtypes, potentially supporting a move toward subtype-specific management strategies. Limitations included lack of medication and mood disorder assessments, but strengths included use of a validated, symptom-specific tool and a nationally representative cohort.

Reference: Shah ED, Almario CV, Spiegel BM, et al. Presentation and Characteristics of Abdominal Pain Vary by Irritable Bowel Syndrome Subtype: Results of a Nationwide Population-Based Study. Am J Gastroenterol. 2020 Feb;115(2):294-301. doi: 10.14309/ajg.0000000000000502. PMID: 31913193; PMCID: PMC7469977.

Irritable bowel syndrome (IBS) is a chronic disorder of the microbiota–gut–brain axis involving abdominal pain, altered bowel habits, visceral hypersensitivity, low-grade inflammation, impaired intestinal barrier function, and altered gut microbiota. Many studies show microbiota differences between IBS and healthy controls, but no single “IBS signature” or clear “healthy microbiota” definition has emerged due to high variability and inconsistent methods. Microbiota-targeted strategies such as the low FODMAP diet and fecal microbiota transplantation (FMT) can relieve symptoms in some patients, but results are mixed, long-term safety is uncertain, and both may affect microbial diversity and gut integrity.

To better understand IBS, researchers are combining molecular biology, advanced neuroimaging, microbiome analysis, and data science. MRI studies show reproducible changes in brain regions tied to pain and emotion, and emerging “radiomicrobiomics” links brain imaging with microbiota and metabolite data. Microbiome work is moving toward more standardized methods, metagenomics for species- and function-level detail, and richer metadata (diet, BMI, age, sex, medications) to reduce confounding. The authors conclude that multimodal, longitudinal, interdisciplinary studies integrating gut microbiota, barrier function, immune markers, neuroimaging, and clinical outcomes are essential to clarify causality in the microbiota–gut–brain axis and to guide more personalized IBS treatments.

Reference: Hillestad EMR, van der Meeren A, Nagaraja BH, et al. Gut bless you: The microbiota-gut-brain axis in irritable bowel syndrome. World J Gastroenterol. 2022 Jan 28;28(4):412-431. doi: 10.3748/wjg.v28.i4.412. PMID: 35125827; PMCID: PMC8790555.

The Rome IV process identifies five bowel disorders, with irritable bowel syndrome (IBS) and functional constipation (FC) being the most common. Food is often a key trigger for gastrointestinal symptoms, making diet manipulation a common first treatment step. Dietary strategies for IBS and FC include general advice, fiber supplementation, the low FODMAP diet (LFD), and other interventions. While general dietary advice from the National Institute for Health and Care Excellence is widely used, the LFD has shown better results, especially for IBS with diarrhea.

The low FODMAP diet is effective in relieving IBS symptoms like pain and bloating by restricting poorly absorbed high FODMAP foods. Although beneficial, its restrictive nature can make long-term adherence difficult. New approaches, including personalized nutrition and targeting specific food types, are emerging. Functional foods such as prunes and kiwifruit also show promise in improving bowel function. Ongoing research into alternative diets and biomarkers is needed for more personalized treatments of bowel disorders.

Reference: Singh P, Tuck C, Gibson PR, et al. The Role of Food in the Treatment of Bowel Disorders: Focus on Irritable Bowel Syndrome and Functional Constipation. Am J Gastroenterol. 2022 Jun 1;117(6):947-957. doi: 10.14309/ajg.0000000000001767. Epub 2022 Apr 8. Erratum in: Am J Gastroenterol. 2024 Jul 1;119(7):1442-1444. doi: 10.14309/ajg.0000000000002297. PMID: 35435179; PMCID: PMC9169760.

This study aimed to explore the prevalence and types of functional gastrointestinal disorders (FGIDs) in patients with eating disorders (EDs) such as anorexia nervosa (AN), bulimia nervosa (BN), and eating disorders not otherwise specified (EDNOS). It also sought to identify predictors of these disorders. A total of 101 female patients, with a mean age of 21 years, completed the Rome II modular questionnaire and other validated self-reported assessments. The results showed that 98% of participants met the criteria for at least one FGID, with the most common being irritable bowel syndrome (IBS), functional heartburn, functional abdominal bloating, and functional constipation. Over half of the sample had at least three coexisting FGIDs.

Psychological factors, including somatization, neuroticism, and anxiety, as well as age and binge eating, were significant predictors of specific FGID types and the presence of multiple coexisting FGIDs. Interestingly, other disordered eating factors, such as body mass index, were not predictive. The study concluded that specific psychological traits play a key role in the development of certain FGIDs in patients with eating disorders, suggesting that addressing these psychological factors may help in managing gastrointestinal symptoms in this population.

Reference: Boyd C, Abraham S, Kellow J. Psychological features are important predictors of functional gastrointestinal disorders in patients with eating disorders. Scand J Gastroenterol. 2005 Aug;40(8):929-35. doi: 10.1080/00365520510015836. PMID: 16170899.

Bloating, distention, and gas are common symptoms among patients with irritable bowel syndrome (IBS), affecting 82.5% of participants in a study of 337 patients with IBS. The prevalence of bloating symptoms was higher in women (87.4%) and those with constipation-predominant (88.7%) or mixed IBS (88.8%) compared to diarrhea-predominant IBS (72.3%). These symptoms were rated as the second most bothersome after abdominal cramping and were a key reason for seeking medical care. Bloating symptoms were linked to decreased quality of life, with patients reporting lower energy, food intake, and physical functioning. Additionally, bloating was associated with increased healthcare utilization and frequent use of anti-gas medications.

The study's findings underscore the high prevalence and significant impact of bloating in IBS, with gender and IBS subtype influencing symptom severity. Patients with bloating sought medical care more frequently and had lower scores in several quality of life domains, including energy and food intake. Although this study focused on bloating in patients with IBS, it also acknowledged that bloating symptoms could stem from nonfunctional conditions, such as small bowel bacterial overgrowth or celiac disease. Further research is needed to explore treatments for bloating symptoms in IBS and their potential to improve patients' overall well-being and reduce healthcare costs.

Reference: Ringel Y, Williams RE, Kalilani L, et al. Prevalence, characteristics, and impact of bloating symptoms in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. 2009 Jan;7(1):68-72; quiz 3. doi: 10.1016/j.cgh.2008.07.008. PMID: 19124113.

This comprehensive systematic review and meta-analysis pooled data from 80 population-based studies encompassing more than 260,000 individuals and estimated a global irritable bowel syndrome (IBS) prevalence of 11.2%. However, prevalence varied markedly (1%-45%) depending on geographic region, diagnostic criteria, and study methodology. Rates were lowest in Southeast Asia (7%) and highest in South America (21%). Diagnostic framework substantially influenced estimates, ranging from 8.8% with Rome I criteria to 14% using Manning criteria. Prevalence was generally higher when symptoms were self-reported through questionnaires rather than interviewer-administered, and when shorter minimum symptom-duration thresholds (e.g., 3 months vs 12 months) were applied. Among IBS subtypes, IBS-D was frequently the most common pattern reported, although studies including IBS-U demonstrated a more balanced distribution across IBS-C, IBS-D, IBS-M, and IBS-U.

Women had a significantly higher likelihood of IBS than men (OR 1.67; 95% CI, 1.53-1.82), while individuals aged ≥50 years had lower odds compared with younger adults (OR 0.75; 95% CI, 0.62-0.92). Socioeconomic status did not show a consistent association with prevalence, although few studies reported these data. Despite substantial heterogeneity across studies, the findings underscore IBS as a prevalent, globally distributed disorder associated with meaningful quality-of-life impairment and economic burden. Variability by geography, methodology, and diagnostic criteria highlights the importance of standardized definitions and the need for additional research in underrepresented regions.

Reference: Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012 Jul;10(7):712-721.e4. doi:10.1016/j.cgh.2012.02.029. PMID: 22426087.

Abdominal bloating and distension are common, often debilitating symptoms affecting up to 90% of irritable bowel syndrome (IBS) patients and about one-third of the general population. Bloating refers to a subjective sensation of gassiness or pressure, while distension is an objective increase in abdominal girth. These symptoms, especially prevalent in women and patients with IBS with constipation, can significantly impair quality of life. Their causes are multifactorial—ranging from small intestinal bacterial overgrowth, carbohydrate intolerance, and celiac disease to disorders of gut-brain interaction, altered motility, pelvic floor dysfunction, and abdominophrenic dyssynergia. Diagnosis relies on detailed history, physical exam, and targeted testing such as breath tests, imaging, and motility studies.

Treatment must be individualized and multifaceted. Dietary interventions, particularly low-FODMAP diets, are often first-line approaches. Depending on the cause, probiotics, rifaximin, secretagogues, prokinetics, or antispasmodics may help. Neuromodulators, biofeedback, and hypnotherapy are effective in patients with visceral hypersensitivity or abnormal reflexes. Complementary therapies like peppermint oil can also provide relief. Ultimately, managing bloating and distension requires identifying key contributing factors and engaging patients in shared decision-making to tailor safe, effective, and sustainable treatments.

Reference: Lacy BE, Cangemi D, Vazquez-Roque M. Management of Chronic Abdominal Distension and Bloating. Clin Gastroenterol Hepatol. 2021 Feb;19(2):219-231.e1. doi: 10.1016/j.cgh.2020.03.056. Epub 2020 Apr 1. PMID: 32246999.

This network meta-analysis evaluated the comparative efficacy and safety of secretagogues (linaclotide, lubiprostone, plecanatide, tenapanor) for treating IBS-C, analyzing data from 15 randomized controlled trials involving 8,462 patients. All secretagogues demonstrated superiority over placebo, with linaclotide 290 µg once daily consistently ranked highest for overall efficacy, particularly for improving abdominal pain and stool frequency. Tenapanor ranked highest for bloating improvement, though differences among drugs were generally minimal.

In terms of safety, plecanatide 6 mg once daily had the most favorable overall adverse event profile, while lubiprostone had the lowest diarrhea rates but was associated with higher rates of nausea. Given the absence of direct head-to-head trials and the limitation of available data beyond 12 weeks, these results provide valuable indirect comparisons to guide clinicians in selecting the most appropriate IBS-C treatment, balancing efficacy, safety, and patient-specific symptom priorities.

Reference: Black CJ, Burr NE, Quigley EMM, et al. Efficacy of Secretagogues in Patients With Irritable Bowel Syndrome With Constipation: Systematic Review and Network Meta-analysis. Gastroenterology. 2018 Dec;155(6):1753-1763. doi: 10.1053/j.gastro.2018.08.021. Epub 2018 Aug 23. Erratum in: Gastroenterology. 2021 May;160(6):2227-2228. doi: 10.1053/j.gastro.2021.04.017. PMID: 30144426.

In this large-scale, multinational study involving 73,076 adults across 33 countries, the global prevalence of functional gastrointestinal disorders (FGIDs) was found to be substantial. Specifically, 40.3% of internet survey respondents and 20.7% of household survey respondents met diagnostic criteria for at least one FGID. Women consistently reported higher prevalence rates than men. FGIDs were linked to significantly decreased quality of life and increased healthcare utilization, highlighting their considerable impact on both individuals and healthcare systems worldwide.

Additionally, this research revealed that the updated Rome IV criteria identified fewer irritable bowel syndrome cases compared to the older Rome III criteria, suggesting stricter diagnostic standards. Despite variations in absolute prevalence between internet-based and in-person data collection methods, consistent trends in demographics, health impacts, and symptom distribution were observed. These findings underscore the global burden of FGIDs and support continued research and healthcare planning tailored to addressing these widespread conditions.

Reference: Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology. 2021 Jan;160(1):99-114.e3. doi: 10.1053/j.gastro.2020.04.014. Epub 2020 Apr 12. PMID: 32294476.

FODMAPs are a group of short-chain carbohydrates (sugars) that are not fully digested or absorbed in the intestines. When they reach the large intestine, they attract water and are fermented by gut bacteria, producing gas. This process causes the intestinal wall to stretch, leading to pain and discomfort, especially for people with irritable bowel syndrome (IBS) who have a sensitive gut. FODMAPs are found naturally in many foods, including fruits, vegetables, dairy, grains, and certain sweeteners. Common types of FODMAPs include oligosaccharides (like fructans in wheat and garlic), disaccharides (like lactose in dairy), monosaccharides (like fructose in fruits), and polyols (like sorbitol in some fruits and artificial sweeteners).

The low FODMAP diet, developed by Monash University, helps manage IBS symptoms by eliminating high FODMAP foods and gradually reintroducing them. It has been shown to improve symptoms like pain, bloating, and altered bowel habits in many patients with IBS, with benefits usually seen within two to six weeks. The diet is recommended for people diagnosed with IBS and should be followed under the guidance of a healthcare professional. For those who do not benefit from the Low FODMAP Diet, other therapies such as stress reduction, hypnotherapy, or medications may be needed.

Reference: FODMAPs and Irritable Bowel Syndrome. Monash University. Accessed February 7, 2025. https://www.monashfodmap.com/about-fodmap-and-ibs/

To diagnose irritable bowel syndrome (IBS), doctors typically review a patient's symptoms, medical and family history, and perform a physical exam. A key part of the diagnosis involves identifying patterns in symptoms, such as abdominal pain linked to bowel movements, changes in stool frequency, and stool appearance. The doctor may diagnose IBS if symptoms have been present at least once a week for the past three months and first started at least six months ago. Additional symptoms such as anemia, rectal bleeding, bloody stools, or weight loss may suggest another condition rather than IBS. During a physical exam, doctors check for abdominal bloating, listen to abdominal sounds, and tap the abdomen to check for tenderness.

While IBS is generally diagnosed based on symptoms, doctors may order tests to rule out other health problems. Blood tests can check for anemia, infection, or other digestive diseases, while stool tests help detect blood or infections. Additional tests, such as a hydrogen breath test, upper gastrointestinal endoscopy, or colonoscopy, may be used if there are concerns about other conditions like small intestinal bacterial overgrowth, celiac disease, or colon cancer. These tests help ensure that IBS is the correct diagnosis and rule out any other potential causes for the symptoms.

Reference: Diagnosis of Irritable Bowel Syndrome. NIDDK. Updated November 2017. Accessed February 7, 2025. https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/diagnosis