Chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C) are complex conditions involving a range of abdominal and bowel symptoms, including bloating, straining, abdominal pain, and hard stools. Effective symptom reporting is essential for diagnosis and individualized treatment, yet many patients delay seeking care due to embarrassment, dissatisfaction with prior healthcare encounters, or inadequate communication with providers. A strong clinician–patient relationship is critical to overcoming these barriers, enabling more accurate symptom reporting, improving health-related quality of life, and enhancing satisfaction with care. Patient-centered communication, shared understanding of symptom experiences, and education on symptom terminology are key components of successful long-term management.

Monitoring treatment response in CIC and IBS-C is equally important. Various patient-reported symptom scales—ranging from global assessments to detailed individual symptom tracking—can help clinicians evaluate treatment efficacy and refine care strategies. While global assessments offer a broad view of symptom burden, individualized symptom tools provide granular insights that guide more tailored treatment decisions. Including patients in discussions about their most bothersome symptoms, treatment expectations, and long-term care goals can improve adherence, outcomes, and overall satisfaction.

Reference: Kassebaum-Ladewski A, Poppers DM, Brenner DM. Effective Communication Strategies and Tools for Improving Treatment Outcomes in Patients With Chronic Idiopathic Constipation and Irritable Bowel Syndrome With Constipation. Am J Gastroenterol. 2022 Apr 1;117(4S):S14-S20. doi: 10.14309/ajg.0000000000001686. PMID: 35354771.

Chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C) are common gastrointestinal disorders, with CIC affecting 11.7% of the global population and IBS-C affecting 1.3%. Despite their prevalence, many individuals do not seek medical treatment, and those who do often turn to primary care after trying lifestyle changes and over-the-counter remedies. This review offers a comprehensive overview of treatment strategies to help healthcare providers improve long-term outcomes for patients with CIC and IBS-C.

Patients with CIC and IBS-C often start with over-the-counter remedies such as fiber and osmotic laxatives, but they may not achieve adequate relief and may be hesitant to use prescription medications due to concerns about dependency. Dietary fiber supplementation, gut microbial alterations, and treatments like probiotics, prebiotics, and osmotic laxatives are commonly recommended, though their efficacy may vary. The review emphasizes the importance of a clinical treatment algorithm and the need for patient education to ensure proper treatment selection. In some cases, combination therapy may be necessary to optimize outcomes. A comprehensive, patient-centered approach, considering both lifestyle factors and the potential for combination treatments, is crucial for managing these complex conditions effectively.

Reference: Brenner DM, Harris LA, Chang CH, et al. Real-World Treatment Strategies to Improve Outcomes in Patients With Chronic Idiopathic Constipation and Irritable Bowel Syndrome With Constipation. Am J Gastroenterol. 2022 Apr 1;117(4S):S21-S26. doi: 10.14309/ajg.0000000000001709. PMID: 35354772.

Researchers explored the relationship between sleep quality and gastrointestinal (GI) symptoms in patients with irritable bowel syndrome (IBS) using both subjective and objective measures. Over a 7-day period, 80 patients tracked their GI symptoms and mood via smartphone 10 times per day, while subjective sleep quality was reported each morning and objective sleep data were collected using wrist-worn actigraphy. The analysis found that a majority of participants experienced significant sleep disturbances, with over 80% screening positive for a sleep disorder, primarily insomnia.

Results showed that poor subjective sleep quality predicted increased abdominal pain and lower GI symptoms the following day, whereas GI symptoms did not predict sleep quality. Interestingly, objective sleep data from actigraphy did not correlate with GI symptoms, suggesting that perceived sleep quality may have a greater impact on IBS symptom severity than measured sleep metrics. These findings highlight the importance of addressing perceived sleep disturbances in IBS management and suggest a potential role for sleep-focused interventions in improving GI symptom outcomes.

Reference: Topan R, Vork L, Fitzke H, et al. Poor Subjective Sleep Quality Predicts Symptoms in Irritable Bowel Syndrome Using the Experience Sampling Method. Am J Gastroenterol. 2024 Jan 1;119(1):155-164. doi: 10.14309/ajg.0000000000002510. Epub 2023 Sep 22. PMID: 37737676; PMCID: PMC10758350.

This study, using data from the Maastricht Irritable Bowel Syndrome cohort, aimed to explore life satisfaction in patients with irritable bowel syndrome (IBS) and identify factors contributing to their overall well-being. The study included 195 patients, with questionnaires assessing gastrointestinal symptoms, life satisfaction, psychological factors, and quality of life. A finite mixture model analysis revealed three latent subgroups, with higher life satisfaction in the group reporting better mental quality of life, lower anxiety and depressive symptoms, and less severe gastrointestinal symptoms. Multivariable regression identified that higher life satisfaction was associated with better physical and mental quality of life, but not gastrointestinal symptom severity. Employment and fewer anxiety symptoms also showed a link to higher satisfaction, though not all factors were statistically significant after multiple testing.

The findings emphasize the importance of addressing both mental and physical quality of life in IBS treatment, as gastrointestinal symptom severity did not independently affect life satisfaction. This highlights the need for a more holistic approach to IBS care, focusing not just on symptom management but also on improving overall well-being. The study suggests that using life satisfaction as an endpoint in clinical trials could provide a more comprehensive measure of patient well-being.

Reference: Snijkers JTW, Winkens B, Weerts ZZRM, et al. Satisfaction With Life in IBS Is Associated With Psychological Burden Rather than Gastrointestinal Symptom Severity. Am J Gastroenterol. 2024 Mar 1;119(3):512-520. doi: 10.14309/ajg.0000000000002547. Epub 2023 Oct 4. PMID: 37791610; PMCID: PMC10904003.

This large, multicenter psychometric validation study assessed the reliability and validity of an experience sampling method-based patient-reported outcome measure (ESM-PROM) for real-time gastrointestinal symptom monitoring in patients with irritable bowel syndrome (IBS). Across 230 participants in three European countries, the ESM-PROM showed strong concurrent validity with end-of-day diaries and moderate correlations with end-of-week questionnaires. It also demonstrated good internal consistency—particularly in core IBS symptom domains—and excellent test-retest reliability. Unlike retrospective reports, which tend to inflate symptom severity due to recall bias, ESM provided a more accurate and ecologically valid representation of patients’ daily symptom experiences, reducing peak reporting bias and capturing moment-to-moment variability.

The ESM-PROM enables nuanced analysis of symptom patterns, triggers, and comorbid psychological and physical states in real-world settings, making it a powerful tool for personalized care and treatment evaluation. Despite its time demands and technical considerations, compliance was high, and the method showed minimal evidence of reactivity or survey fatigue. This tool has the potential to enhance clinical decision-making, self-management, and research into IBS pathophysiology and treatment efficacy. However, future research is needed to confirm its responsiveness to treatment interventions and to define its optimal use in various clinical and research scenarios.

Reference: Bosman M, Vork L, Jonkers D, et al. Results From a Psychometric Validation Study: Patients With Irritable Bowel Syndrome Report Higher Symptom Burden Using End-of-Day Vs Real-Time Assessment. Am J Gastroenterol. 2025 May 1;120(5):1098-1107. doi: 10.14309/ajg.0000000000003091. Epub 2024 Sep 23. PMID: 39311432; PMCID: PMC12043265.

Irritable bowel syndrome (IBS) is typically monitored using retrospective symptom assessments, which are prone to recall and ecological biases, often leading to exaggerated symptom reports. This study evaluated the validity and reliability of an electronic experience sampling method (ESM)-based patient-reported outcome measure (PROM) designed for real-time IBS symptom assessment. Involving 230 patients with IBS across multiple European centers, the study demonstrated strong validity and reliability of the ESM-PROM, showing robust correlations with traditional end-of-day diaries but with significantly less symptom exaggeration.

The ESM-PROM effectively captured moment-to-moment variability and real-life symptom patterns, providing more precise insights into symptom fluctuations and their triggers compared to retrospective methods. While more demanding in terms of patient compliance, the method had high adherence (71% completion rate), demonstrated good-to-excellent internal consistency, and excellent test-retest reliability. These findings suggest that ESM-PROM represents a valuable clinical tool for personalized IBS management, offering accurate symptom tracking and improved monitoring of treatment response.

Reference: Bosman M, Vork L, Jonkers D, et al. Results From a Psychometric Validation Study: Patients With Irritable Bowel Syndrome Report Higher Symptom Burden Using End-of-Day Vs Real-Time Assessment. Am J Gastroenterol. 2024 Sep 23. doi: 10.14309/ajg.0000000000003091. Epub ahead of print. PMID: 39311432.

In a cross-sectional survey conducted between January and March 2022 across 13 Italian cities, investigators evaluated the prevalence of self-reported nonceliac gluten sensitivity (NCGS) among young adults meeting Rome IV criteria for irritable bowel syndrome (IBS). Of 5,108 valid responses, 819 participants (16%) met criteria for IBS. Among these, 238 individuals (29.1%) also fulfilled criteria for NCGS. The prevalence of NCGS was significantly higher in participants with IBS compared with those without IBS (29.1% vs 8.6%, P<0.0001), underscoring the substantial clinical overlap and diagnostic complexity between these two conditions.

Compared with patients with IBS without NCGS, those classified as IBS-NCGS more frequently reported extraintestinal symptoms, including fatigue, “brain fog,” and diminished overall well-being, as well as higher rates of neuropsychiatric disorders (P<0.05). Adherence to a gluten-free diet was also significantly greater in the IBS-NCGS group (60.9% vs 40.5%, P<0.0001). These findings suggest that nearly one-third of individuals with IBS may also meet criteria for NCGS and that recognizing this subgroup—particularly those with prominent extraintestinal features—may help refine dietary counseling and optimize individualized symptom management strategies.

Reference: Brindicci VF, Cristofori F, Franceschini S, et al. Self-reported Nonceliac Gluten Sensitivity in Patients With Irritable Bowel Syndrome: A Cross-sectional Analysis. J Clin Gastroenterol. 2026 Jan 30. doi: 10.1097/MCG.0000000000002306. Epub ahead of print. PMID: 41609762.

Chronic constipation, including functional constipation (FC) and constipation-predominant irritable bowel syndrome (IBS-C), is common and significantly affects quality of life. Both conditions share symptoms like infrequent bowel movements, straining, and a sensation of incomplete evacuation, but IBS-C is further characterized by abdominal pain. This pain, a major contributor to disease burden, involves complex mechanisms such as abnormal gut distension, sensory nerve activation, and disrupted motility. Factors like diet, gut microbiota, serotonin metabolism, and genetic predisposition all influence pain perception. The overlap in symptoms suggests that FC and IBS-C may be part of a spectrum, rather than entirely distinct disorders.

Managing abdominal pain in constipation requires a multimodal approach targeting motility, hypersensitivity, and neuroimmune regulation. Treatments like laxatives, 5-HT4 agonists, and guanylate cyclase-C agonists can relieve symptoms but may have side effects. Psychological therapies, including cognitive-behavioral therapy and antidepressants, help address central pain mechanisms but show variable responses. Probiotics and acupuncture show potential but lack consistent evidence. Future research should focus on understanding the mechanisms, identifying biomarkers, and exploring innovative diagnostic and treatment strategies, like multi-omics studies and machine learning, to improve outcomes for patients with IBS-C and FC.

Reference: Luo J, Xu Q, Xu S, et al. Decoding Abdominal Pain in Constipation-predominant Irritable Bowel Syndrome and Functional Constipation: Mechanisms and Managements. Curr Gastroenterol Rep. 2025 Mar 17;27(1):22. doi: 10.1007/s11894-025-00967-7. PMID: 40095229; PMCID: PMC11914341.

This literature review examined the relationship between diet and irritable bowel syndrome with constipation (IBS-C). It emphasized the role of gut microbiota imbalances in IBS-C, noting that factors such as diet, genetics, and gastrointestinal motility influence microbiota composition, which in turn affects IBS-C symptoms. Key findings included changes in microbial populations, such as increased Firmicutes and decreased Bacteroidetes, in patients with IBS-C. Additionally, methane production was found to correlate with constipation severity, highlighting the complex interaction between the microbiota and IBS-C symptoms.

The review also explored dietary approaches for managing IBS-C, such as the low-FODMAP diet and fiber supplementation. While the low-FODMAP diet can alleviate symptoms by reducing fermentable carbohydrates, its long-term effectiveness for IBS-C requires further study. Soluble fibers like psyllium and inulin were shown to improve bowel function and stool consistency. The review also considered the potential benefits of prebiotics, probiotics, and fecal microbiota transplantation in modulating the microbiota and relieving symptoms. Despite promising results, the review concludes that a personalized, multifaceted dietary approach is essential for managing IBS-C, with further research needed to determine the best long-term dietary strategies.

Reference: Di Rosa C, Altomare A, Terrigno V, et al. Constipation-Predominant Irritable Bowel Syndrome (IBS-C): Effects of Different Nutritional Patterns on Intestinal Dysbiosis and Symptoms. Nutrients. 2023 Mar 28;15(7):1647. doi: 10.3390/nu15071647. PMID: 37049488; PMCID: PMC10096616.

In this case study, a 47-year-old woman reports several years of constipation with worsening lower abdominal pain and frequent straining over the past 3 years. She has 2-3 bowel movements per week with pellet-like or large, hard stools, occasional small stool leakage, pain that improves after defecation, and a persistent sense of incomplete evacuation. She has fibromyalgia and anxiety, no alarm features (no weight loss, bleeding, or nocturnal symptoms), normal labs, and a prior colonoscopy notable only for diverticulosis. Multiple OTC constipation remedies provided only modest relief, and she stopped dicyclomine due to side effects and lack of benefit. Her symptoms significantly impair quality of life, causing missed work and anxiety about job/insurance.

She was started on linaclotide 145 µg daily but used it only 3-4 days/week due to diarrhea and urgency. Bowel frequency and stool consistency improved, but abdominal pain remained severe. The dose was increased to 290 µg daily. At follow-up, she reported ~50% improvement in pain but ongoing bothersome symptoms and continued work disruption, prompting a discussion about raising expectations and reviewing additional options. The accompanying overview frames this presentation as consistent with IBS-C (pain plus constipation per Rome IV) and emphasizes individualized management, setting clear goals for “satisfactory” symptom control, and considering alternative FDA-approved therapies and adjunct evaluation when response is incomplete. In the case’s course, she was transitioned to tenapanor and evaluated for pelvic floor dysfunction. Testing suggested dyssynergic defecation, and referral for biofeedback/pelvic floor therapy improved bowel completeness.

Reference: Sayuk GS. Raising the Bar in the Management of IBS-C. Gastroenterol Hepatol (N Y). 2023 Oct;19(10):613-620. PMID: 38404960; PMCID: PMC10882853.

Chronic constipation affects about 14% of the global population and includes functional constipation (FC) and constipation-predominant irritable bowel syndrome with constipation (IBS-C), which likely exist along a spectrum rather than as separate disorders. Although recurrent, defecation-related abdominal pain distinguishes IBS-C from FC, pain also occurs in FC and patients may shift between diagnoses over time. Abdominal pain arises from interacting mechanisms: fecal retention and gas causing distension; diet and high-FODMAP foods provoking visceral hypersensitivity and immune activation (especially in IBS-C); and gut microbiota dysbiosis, low-grade inflammation, serotonin imbalance, genetic/epigenetic variants, stress, sex hormones, and central and peripheral nervous system changes modulating pain pathways.

Managing abdominal pain in constipation is difficult and usually requires a multimodal, individualized approach. Conventional therapies (antispasmodics, peppermint oil, laxatives) can ease motility-related discomfort but have limited or inconsistent evidence for direct pain relief. Newer agents—5-HT₄ agonists, guanylate cyclase-C agonists, NHE3 inhibitors, and chloride channel activators—target motility and visceral sensitivity but are constrained by side effects, safety concerns, or scarce long-term data. Central approaches (antidepressants, CBT, gut-directed hypnotherapy) address altered pain processing yet are limited by tolerability and variable response. Microbiota-focused and complementary therapies (probiotics, acupuncture, herbal formulations) show promise but lack methodological rigor and standardization. Future longitudinal, multi-omics studies using advanced analytics are needed to clarify mechanisms, identify biomarkers, and enable mechanism-based, patient-centered treatment of abdominal pain in IBS-C and FC.

Reference: Luo J, Xu Q, Xu S, et al. Decoding Abdominal Pain in Constipation-predominant Irritable Bowel Syndrome and Functional Constipation: Mechanisms and Managements. Curr Gastroenterol Rep. 2025 Mar 17;27(1):22. doi: 10.1007/s11894-025-00967-7. PMID: 40095229; PMCID: PMC11914341.

Authors of a scoping review of 27 clinical practice guidelines (CPGs) from 2012 to 2024 found considerable inconsistency in diagnostic criteria for constipation-predominant IBS (IBS-C) and functional constipation (FC). Rome IV was most commonly used (59.3%), followed by Rome III (22.2%). IBS-C guidelines emphasized abdominal pain (71.4%), whereas FC guidelines prioritized spontaneous bowel movement frequency (88.9%). IBS-C CPGs often endorsed positive, symptom-based diagnosis (71.4%) versus far fewer FC CPGs (11.1%). Forty percent of CPGs acknowledged overlap between IBS-C and FC. One guideline proposed a pain threshold (Likert >4) to define “painful constipation.” Regional variation was notable: some Asian-based CPGs highlighted Bristol Stool Form Scale type 3 and abdominal bloating; most CPGs (81.5%) recommended colonoscopy only for alarm features or age criteria. These discrepancies likely skew prevalence estimates, payer policies, and clinical trial eligibility across regions.

Overall, the landscape is fragmented and region-dependent, complicating differential diagnosis and care pathways. The authors call for harmonized criteria that better integrate both pain and constipation domains across IBS-C and FC, and for progress toward objective biomarkers to reduce reliance on symptoms alone. As an interim step, standardized reporting of stool form, pain intensity scales, and symptom duration could improve comparability across settings while biomarker research matures.

Reference: Luo J, To WLW, Xu Q, et al. Clinical practice guidelines for the diagnosis of constipation-predominant irritable bowel syndrome and functional constipation in adults: a scoping review. BMC Gastroenterol. 2025;25(1):234. doi: 10.1186/s12876-025-03774-6.

This systematic review aimed to evaluate the effectiveness of kiwifruit or kiwifruit extracts in treating constipation by analyzing randomized controlled trials (RCTs). A total of seven RCTs involving 399 participants (82% female, average age 42 years) were included. The review assessed outcomes such as the frequency of spontaneous bowel movements (SBM), abdominal pain, straining, and stool type. Compared to placebo, kiwifruit extracts may slightly increase SBM frequency with low certainty, and it had an uncertain effect on stool type with very low certainty. Kiwifruit also showed moderate evidence for reducing abdominal pain but had a negligible impact on straining.

The review found that kiwifruit might increase SBM compared to psyllium, with moderate certainty, and may also improve stool softness, though the evidence remains inconclusive. Kiwifruit extracts also potentially led to more minor adverse events than placebo. Overall, the evidence supporting kiwifruit as an effective treatment for constipation is of low certainty. While promising, researchers stress that larger and more methodologically robust studies are needed to confirm its role in constipation management.

Reference: Eltorki M, Leong R, Ratcliffe EM. Kiwifruit and Kiwifruit Extracts for Treatment of Constipation: A Systematic Review and Meta-Analysis. Can J Gastroenterol Hepatol. 2022 Oct 6;2022:7596920. doi: 10.1155/2022/7596920. PMID: 36247043; PMCID: PMC9560827.

A recent article outlined a patient-centered approach to IBS-C through the case of “CS,” a 40-year-old female internist with lifelong constipation and escalating abdominal symptoms (bloating, pain, incomplete evacuation, straining) that markedly reduced quality of life. Over-the-counter measures (high fiber, water, PEG, magnesium, Metamucil) helped produce bowel movements but caused “overflow diarrhea,” urgency, and ongoing daylong discomfort. She was diagnosed with IBS-C and started on linaclotide 145 µg daily, which improved evacuation but triggered significant diarrhea and urgency. Every-other-day dosing reduced diarrhea but led to symptom relapse on off days, with persistent straining raising concern for complications.

The piece emphasizes making a confident diagnosis using a positive diagnostic strategy (Rome IV criteria + symptom burden/QOL impact + clinical confidence other diagnoses are ruled out) and subtyping with the Bristol Stool Form Scale. It reviews FDA-approved IBS-C options with different mechanisms (secretagogues: lubiprostone, linaclotide, plecanatide; retainagogue: tenapanor), noting that head-to-head comparisons are lacking—so treatment often requires trial-and-error supported by follow-up and symptom tracking across both bowel and abdominal domains. CS switched to tenapanor 50 mg twice daily and reported good overall control with more manageable diarrhea. Key takeaways include building trust, documenting all symptoms, setting expectations that abdominal relief may lag bowel response, reassessing around 8 weeks, and switching to a different mechanism of action if response is inadequate.

Reference: Kongara K. Patient-Centered Approach in IBS-C Management. Gastroenterol Hepatol (N Y). 2025 Jun;21(6):362-373. PMID: 40896757; PMCID: PMC12397800.

Across multiple ACG 2025 reports, tenapanor (50 mg BID) showed consistent benefit for IBS-C—especially bloating. In a pooled post hoc analysis of 3 trials (n=1253 with moderate to severe baseline bloating), tenapanor delivered a greater 12-week reduction vs placebo (LS mean change −2.66 vs −2.10; difference −0.57; P=.0003) with faster onset (median time to ≥30% bloating improvement 5 vs 8 weeks; P<.0001). Safety signals were largely GI, with diarrhea the most common drug-related AE (~13% vs ~2% placebo) and serious TEAEs uncommon. A meta-analysis similarly showed improvements across abdominal symptoms and CSBMs, with higher treatment-related AEs/discontinuations (again mainly diarrhea) but no clear increase in serious AEs. Real-world data echoed these findings: high satisfaction (~88%), broad symptom/quality of life (QOL) gains, and EHR signals of fewer GI visits and portal messages, especially among high utilizers.

For plecanatide (GC-C agonist), pooled phase 3 analyses showed concurrent improvements in pain, bloating, and CSBMs, including in women 18–40 with bloating; diarrhea remained the most common AE (low single-digit rates). Another post hoc analysis found plecanatide can improve HRQOL even without meeting the FDA stool-frequency responder definition (clinically meaningful IBS-QOL improvement at Week 12: 36.9% vs 28.8% placebo). A FAERS-based safety review across linaclotide, lubiprostone, plecanatide, and tenapanor found most reports were nonserious and GI, while noting FAERS can’t establish incidence/causality. In pediatrics, a meta-analysis suggested linaclotide may improve stool consistency and straining but has limited effects on CSBMs, abdominal pain, or bloating, with AE rates not clearly different from placebo.

Reference: Gastroenterology & Hepatology. Highlights in IBS-C From the American College of Gastroenterology 2025 Annual Scientific Meeting: A review of selected presentations from the ACG 2025 Annual Scientific Meeting (October 24-29, 2025; Phoenix, AZ). Gastroenterol Hepatol (N Y). 2025 Nov;21(11 Suppl 8) (Special Meeting Review Edition).

This study aimed to compare pelvic floor symptoms, such as pelvic organ prolapse (POP) and lower urinary tract symptoms (LUTS), between patients with irritable bowel syndrome with constipation (IBS-C) and functional constipation (FC). It also examined their correlation with anorectal manometry (ARM) findings. The researchers used the Pelvic Floor Distress Inventory (PFDI-20) to assess pelvic floor distress and the Constipation Severity Scale to measure the severity of constipation. A total of 107 patients (64 with FC and 43 with IBS-C) participated in the analysis.

The study found that patients with IBS-C experienced higher levels of distress from POP, LUTS, and colorectal symptoms compared to those with FC. Multivariable regression analysis showed that IBS-C and higher constipation severity were independently associated with higher PFDI-20 scores. However, no correlation was found between ARM parameters, abnormal balloon expulsion tests, and PFDI scores. These results suggest that patients with IBS-C experience greater pelvic floor symptom distress than FC patients The severity of constipation also plays a role in this distress, although dyssynergia (abnormal anorectal function) did not contribute to the findings.

Reference: Singh P, Seo Y, Ballou S, et al. Pelvic Floor Symptom Related Distress in Chronic Constipation Correlates With a Diagnosis of Irritable Bowel Syndrome With Constipation and Constipation Severity but Not Pelvic Floor Dyssynergia. J Neurogastroenterol Motil. 2019 Jan 31;25(1):129-136. doi: 10.5056/jnm17139. PMID: 30646484; PMCID: PMC6326213.

Recent research has highlighted the role of the gut microbiota and bile acids (BAs) in the development of irritable bowel syndrome (IBS), particularly in patients with IBS-D. Bile acids, produced in the liver and metabolized by the gut microbiota, influence gut functions such as fluid secretion, mucosal permeability, and motility. In patients with IBS, altered microbiota profiles and modified BA profiles have been observed. Microbial transformations of primary BAs, including deconjugation and 7α-dehydroxylation, produce secondary BAs that affect gut physiology. These transformations are essential for the regulation of gut health and may contribute to the pathophysiology of IBS. Additionally, the reciprocal relationship between BA profiles and gut dysbiosis could provide insights into IBS development.

Clinical studies have shown differences in BA profiles between IBS patients and healthy controls, with patients with IBS-D exhibiting altered BA profiles and increased primary BA levels. Studies also suggest that altered BA profiles correlate with abdominal pain, stool consistency, and stool frequency. Moreover, the abundance of specific gut microbiota, including Clostridia and E. coli, has been associated with BA excretion patterns in IBS-D. However, more research is needed to establish causal relationships between BA profiles, gut microbiota, and IBS symptoms. 

Reference: Min YW, Rezaie A, Pimentel M. Bile Acid and Gut Microbiota in Irritable Bowel Syndrome. J Neurogastroenterol Motil. 2022 Oct 30;28(4):549-561. doi: 10.5056/jnm22129. PMID: 36250362; PMCID: PMC9577585.

IBS is a common, chronic gut–brain disorder defined by recurrent abdominal pain with changes in stool form or frequency, diagnosed using Rome IV–based symptom criteria once alarm features and organic disease are excluded. Because IBS has multifactorial pathophysiology—altered motility, visceral hypersensitivity, microbiota changes, immune activation, stress, psychological comorbidity, and genetics—treatments are often symptom-focused and unsatisfactory. The Korean Society of Neurogastroenterology and Motility (KSNM) therefore updated its national IBS guidelines to provide practical, evidence-based recommendations for adults, spanning definition, risk factors, diagnosis, and management.

The 2023–2024 “Seoul Consensus” guidelines were developed by a multidisciplinary group using systematic searches, meta-analyses, GRADE evidence grading, and a two-round Delphi process to finalize 22 recommendations. They endorse a positive diagnostic strategy (rather than exhaustive exclusion) with focused history, limited labs, and colonoscopy reserved for alarm features, lack of screening, or refractory symptoms. Management starts with lifestyle and dietary measures, particularly a structured low-FODMAP approach and gentle physical activity, then adds targeted therapies: soluble fiber and PEG for IBS-C; loperamide, 5-HT₃ antagonists, and rifaximin for IBS-D; antispasmodics, TCAs, and sometimes SSRIs for global symptoms and pain; and secretagogues/GC-C agonists or lubiprostone for persistent constipation. Probiotics and gut-directed psychotherapies are conditionally recommended as adjuncts. The guidelines aim to standardize care, reduce unnecessary testing and costs, and support individualized, stepwise treatment, with updates planned every 3–5 years.Top of Form

Reference: Choi Y, Youn YH, Kang SJ, et al. 2025 Seoul Consensus on Clinical Practice Guidelines for Irritable Bowel Syndrome. J Neurogastroenterol Motil. 2025 Apr 30;31(2):133-169. doi: 10.5056/jnm25007. PMID: 40205893; PMCID: PMC11986658.

This study examined 230 patients diagnosed with functional constipation (FC) or constipation-predominant irritable bowel syndrome (IBS-C) using colonic transit tests, high-resolution anorectal manometry (HR-ARM), and psychological assessments. Though demographic and symptom profiles between the groups were similar, patients with IBS-C showed a higher prevalence of slow colonic transit, while rectosigmoid accumulation (RSARM)—a potential marker of dyssynergic defecation—was more common in FC. Both groups displayed high rates of dyssynergic patterns on HR-ARM, though the specific types differed slightly. Importantly, depression was significantly more prevalent in patients with IBS-C, and correlations were found between psychological distress and altered anorectal sensory thresholds, suggesting emotional factors may play a more influential role in IBS-C than in FC.

The study highlights that while clinical symptoms, manometry, and sensory thresholds can help characterize these subtypes of chronic constipation, they alone are insufficient to reliably distinguish IBS-C from FC. RSARM combined with specific dyssynergic patterns (type IV in FC and type III in IBS-C) may serve as useful indicators for identifying dyssynergic defecation, potentially guiding therapy. However, due to limitations in sample size and hospital-based recruitment, the findings may not be generalizable. Future research should include broader patient populations and investigate whether psychological and physiological profiles can more accurately inform tailored diagnostic and treatment strategies.

Reference: Lv CL, Song GQ, Liu J, et al. Colorectal motility patterns and psychiatric traits in functional constipation and constipation-predominant irritable bowel syndrome: A study from China. World J Gastroenterol. 2023 Nov 7;29(41):5657-5667. doi: 10.3748/wjg.v29.i41.5657. PMID: 38077156; PMCID: PMC10701329.