This network meta-analysis aimed to compare the efficacy of secretagogues for treating irritable bowel syndrome with constipation (IBS-C) by evaluating randomized controlled trials (RCTs) published until June 2018. The study included 15 eligible trials with 8,462 patients and analyzed the effects of linaclotide, lubiprostone, plecanatide, and tenapanor, all of which were superior to placebo. Linaclotide (290 μg once daily) ranked first in terms of efficacy, including outcomes like abdominal pain and complete spontaneous bowel movements, while tenapanor (50 mg twice daily) ranked first for decreasing bloating. The analysis also revealed that diarrhea was more common with all drugs except lubiprostone, and nausea was more frequent with lubiprostone.

Despite finding that all secretagogues outperformed placebo, the study highlighted that the long-term efficacy of these treatments remains unclear, as the data were assessed at the 12-week time point. While the efficacy across most endpoints was similar among the drugs, safety profiles varied. Plecanatide (6 mg once daily) was ranked first for safety, although linaclotide and plecanatide at higher doses had significantly more adverse events compared to placebo. The findings suggest that all four secretagogues are effective for IBS-C, but further research is needed to determine their long-term efficacy and safety profiles.

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.

Irritable bowel syndrome (IBS) impacts roughly 5% to 10% of people and is defined by chronic abdominal pain linked to defecation with altered stool form or frequency. Most cases can be diagnosed clinically with limited tests (eg, basic labs, coeliac serology), avoiding exhaustive workups that rarely reassure. Initial management targets the patient’s dominant symptom with simple diet/lifestyle steps: regular meals, hydration, reduced caffeine/alcohol and processed foods, gradual introduction of soluble fiber, a trial of combination probiotics for up to 12 weeks, and increased physical activity.

For pain/bloating, antispasmodics and specific peppermint-oil formulations may help. Loperamide can firm stools but has limited impact on global IBS, and polyethylene glycol may increase bowel frequency in IBS with constipation but not pain. If first-line drugs are inadequate, central neuromodulators can be effective. For IBS-C unresponsive to laxatives, secretagogues can improve global symptoms and stool form. For IBS with diarrhea, rifaximin and eluxadoline offer modest benefits and availability varies, while 5-HT3 antagonists appear most efficacious. Psychological therapies have the strongest evidence, and earlier referral may prevent chronicity.

Top of Form

Reference: Black CJ, Ford AC. Best management of irritable bowel syndrome. Frontline Gastroenterol. 2020;12(4):303-315. doi: 10.1136/flgastro-2019-101298.

The American College of Gastroenterology (ACG) is dedicated to advancing digestive health and improving patient outcomes through a variety of educational resources, guidelines, and professional development opportunities. It offers numerous tools for both healthcare professionals and patients, including clinical guidelines, educational events, and research opportunities. The ACG also provides a membership platform with benefits such as access to journals, continuing medical education, and networking opportunities. Resources like GI OnDEMAND, virtual grand rounds, and the GI Circle Communities are available to help members stay up-to-date on the latest in gastroenterology.

For patients and families, the ACG offers a wealth of information on gastrointestinal health, including resources on common conditions such as irritable bowel syndrome and inflammatory bowel disease. Through its website, the ACG also provides access to tools for finding gastroenterologists and educational materials to improve patient understanding of digestive diseases. In addition, the ACG focuses on leadership, ethics, and equity through its various leadership programs and research awards. The organization continues to foster a strong professional network and supports the development of emerging leaders in the field of gastroenterology.

Reference: American College of Gastroenterology. Irritable Bowel Syndrome (IBS). American College of Gastroenterology. Accessed March 10, 2025. https://gi.org/topics/irritable-bowel-syndrome/

Chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C) produce overlapping symptoms—constipation, bloating/distension, and pain—likely along a spectrum where pain/hypersensitivity is more prominent in IBS-C. Both conditions carry heavy quality-of-life impacts and common comorbidities, though profiles differ (CIC: diabetes/obesity; IBS-C: anxiety/depression, functional dyspepsia, fibromyalgia, interstitial cystitis). BURDEN studies show a wide patient-clinician perception gap and low satisfaction with care: many patients rely on over-the-counter (OTC) medications, few feel in control, and stigma or uncertainty keeps many from seeking help or receiving a firm diagnosis—fueling unnecessary tests and anxiety.

The economic and treatment burdens are substantial: frequent outpatient visits, high use of imaging/colonoscopy despite limited diagnostic yield, and insurer hurdles. Most patients self-manage with OTCs. Prescription uptake is low, and treatment-emergent diarrhea is a frequent reason for discontinuation. Sex and cultural factors shape illness experience and care-seeking (eg, lower health-related quality of lfie and more bloating in women; variable healthcare use by sex and ethnicity). Because CIC and IBS-C often overlap and fluctuate, management should be individualized and patient-centric, which includes aligning on diagnosis and goals, addressing comorbidities and psychosocial drivers, tailoring therapy to the most bothersome symptoms, using prescriptions when indicated, avoiding low-value testing, and planning for adverse-event management to improve outcomes and reduce social/economic burden.

Reference: Harris LA, Chang CH. Burden of Constipation: Looking Beyond Bowel Movements. Am J Gastroenterol. 2022;117(4S):S2-S5. doi: 10.14309/ajg.0000000000001708.

The BURDEN IBS-C study compared the experiences, attitudes, and unmet needs of individuals with irritable bowel syndrome with constipation (IBS-C) to those of healthcare providers (HCPs). The survey included 1,311 patients and 331 HCPs. Results showed that while most patients used over-the-counter (OTC) treatments (86%) or were currently using them (76%), only 12% were on prescription therapy. A significant portion of both patients (66%) and HCPs (79%) expressed dissatisfaction with treatments, citing inadequate efficacy and side effects, particularly diarrhea.

The study also explored the emotional and lifestyle impact of IBS-C. Patients reported feeling frustrated (43%) and stressed (28%), with 39% accepting IBS-C as part of their daily life. In contrast, HCPs recognized patients' frustration and stress (76% and 65%, respectively) but were less aware of patients’ acceptance of the condition (13%). IBS-C symptoms impacted productivity and personal activities, averaging 4 and 3 days per month. The findings suggest that current treatments do not fully meet the needs of IBS-C patients, highlighting the need for improved treatment options and communication between patients and HCPs.

Reference: Quigley EMM, Horn J, Kissous-Hunt M, et al. Better Understanding and Recognition of the Disconnects, Experiences, and Needs of Patients with Irritable Bowel Syndrome with Constipation (BURDEN IBS-C) Study: Results of an Online Questionnaire. Adv Ther. 2018 Jul;35(7):967-980. doi: 10.1007/s12325-018-0733-x. Epub 2018 Jun 26. PMID: 29946799; PMCID: PMC11343793.

Over the past decade, new therapies for irritable bowel syndrome with constipation (IBS-C) have emerged, but treatment options remain limited for patients unresponsive to secretagogues. Tenapanor, a sodium/hydrogen exchanger 3 inhibitor, offers a novel mechanism of action by reducing sodium absorption in the intestines, leading to increased intestinal fluid and softer stools. Initially developed for hyperphosphatemia, tenapanor demonstrated GI benefits and minimal systemic availability. Preclinical studies showed tenapanor reduced intestinal permeability and visceral hypersensitivity. Early-phase clinical trials confirmed its safety, tolerability, and favorable pharmacodynamics, with mild GI-related adverse events.

Tenapanor’s efficacy was further validated in Phase II and III trials, where it significantly improved both bowel function and abdominal symptoms in patients with IBS-C. The drug met FDA responder endpoints, improved quality of life scores, and was well tolerated aside from diarrhea being the most frequent side effect. Approved by the FDA in 2019, tenapanor is now a recommended option for patients with IBS-C who are unresponsive to first-line treatments like fiber or polyethylene glycol. Unlike serotonin agonists, tenapanor has no cardiovascular restrictions and presents a distinct, safe alternative. However, treatment decisions will likely continue to be shaped by cost and comparative safety data across available pharmacologic agents.

Reference: Herekar A, Shimoga D, Jehangir A, et al. Tenapanor in the Treatment of Irritable Bowel Syndrome with Constipation: Discovery, Efficacy, and Role in Management. Clin Exp Gastroenterol. 2023 Jun 7;16:79-85. doi: 10.2147/CEG.S384251. PMID: 37309470; PMCID: PMC10257918.

Accurate diagnosis of constipation-predominant irritable bowel syndrome (IBS-C) can be challenging due to symptom subjectivity and overlapping etiologies such as functional, structural, metabolic, and medication-related causes. Misinterpretation of symptoms and self-medication with over-the-counter laxatives may mask underlying conditions, delay appropriate treatment, and increase the risk of mismanagement. A thorough, systematic clinical approach—including detailed history-taking, use of validated criteria, and appropriate diagnostic testing—is essential to differentiate functional constipation from secondary causes and guide effective treatment.

In response to the limitations of conventional treatments, herbal remedies have garnered increasing attention for their potential to alleviate IBS-C symptoms. This systematic review identified and evaluated nine studies on various herbal interventions, including padma lax, Chinese herbal medicine, Persian herbal syrup, and others like kiwifruit and geraniol. While some demonstrated statistically significant improvements in bowel habits, symptom severity, and quality of life, issues such as small sample sizes, lack of standardization, and insufficient regulatory oversight remain major concerns. Overall, the findings suggest that herbal therapies may offer complementary symptom relief in IBS-C, but high-quality, large-scale trials are urgently needed to validate their efficacy and safety and inform clinical practice.

Reference: Chiarioni G, Popa SL, Ismaiel A, et al. Herbal Remedies for Constipation-Predominant Irritable Bowel Syndrome: A Systematic Review of Randomized Controlled Trials. Nutrients. 2023 Sep 29;15(19):4216. doi: 10.3390/nu15194216. PMID: 37836500; PMCID: PMC10574070.

A 23-year-old biology PhD candidate has experienced gastrointestinal symptoms for the past three years, including recurrent abdominal pain, bloating, and constipation. Despite trying dietary changes (gluten-free, lactose-free, and low-FODMAP), polyethylene glycol 3350, and cognitive behavioral therapy, her symptoms persist, severely affecting her quality of life. She spends hours in the restroom, leading to missed deadlines and concerns about funding. After a thorough evaluation, she was diagnosed with irritable bowel syndrome with constipation (IBS-C) and referred to gastroenterology for further management.

IBS-C, characterized by abdominal pain and constipation, is common in women and younger individuals. It has a multifactorial pathophysiology, including gut motility changes, microbiome-immune interactions, and gut permeability. Treatments for IBS-C have evolved, with FDA-approved agents like lubiprostone, linaclotide, plecanatide, and tenapanor targeting different mechanisms to offer symptom relief. However, current therapies are not universally effective, so treatment must be individualized based on factors such as symptoms, safety, and patient preferences.

Reference: Brenner DM. Mechanism of Action Considerations in the Management of IBS-C. Gastroenterol Hepatol (N Y). 2023 Dec;19(12):749-756. PMID: 38404415; PMCID: PMC10885421.

In this patient case study, JP, a 24-year-old male, presents with a yearlong history of lower abdominal pain, bloating, and infrequent, difficult-to-evacuate stools, following a stressful trip during which he experienced personal turmoil and restroom access issues. Given the chronicity, normal lab results (complete blood count [CBC], metabolic profile, thyroid tests, C-reactive protein [CRP], celiac serologies), and normal colonoscopy, JP meets the Rome IV diagnostic criteria for irritable bowel syndrome with constipation (IBS-C). Importantly, his history lacks alarm features such as significant weight loss, bleeding, or nocturnal symptoms, suggesting no serious underlying organic disease.

IBS-C is chronic, often persisting for many years if untreated, negatively impacting quality of life but not lifespan or cancer risk. Excessive diagnostic testing beyond initial screening (CBC, CRP, celiac serologies) is generally unnecessary and can lead to anxiety and unnecessary procedures. Dietary adjustments, such as increased fiber or low-FODMAP diets, offer limited benefits for IBS-C specifically. Instead, treatment typically involves FDA-approved medications like lubiprostone, linaclotide, plecanatide (secretagogues), or tenapanor (retainagogue), all of which target abdominal pain, stool consistency, and bowel frequency effectively. Patients should be advised of potential side effects, predominantly diarrhea, and understand that treatment response can occur quickly for constipation but more slowly for abdominal symptoms.

Reference: Lacy BE. Managing IBS-C: Focus on Symptom Control. Gastroenterol Hepatol (NY). 2024 Apr;20(4):216-226. PMID: 38682119; PMCID: PMC11047151.

Irritable bowel syndrome (IBS) is a chronic condition of the gut-brain axis, marked by recurrent abdominal pain, altered bowel movements, and bloating. IBS is categorized into four subtypes, with IBS with constipation (IBS-C) accounting for about one-third of cases. It is diagnosed using the Rome IV criteria, which require abdominal pain and altered bowel habits, such as infrequent, hard stools. IBS-C is influenced by multiple factors including gut motility changes, intestinal permeability, visceral hypersensitivity, immune dysfunction, and gut microbiota changes. Psychosocial factors like anxiety and trauma can exacerbate symptoms, and IBS often overlaps with conditions like GERD and functional dyspepsia.

Treatment for IBS-C typically starts with lifestyle changes, such as a low-FODMAP diet, and nonpharmacologic options like soluble fiber supplements. For more severe cases, FDA-approved medications like lubiprostone, linaclotide, plecanatide, and tenapanor are used to improve symptoms by increasing intestinal fluid and motility. Psychological therapies, including cognitive-behavioral therapy, may also help with persistent pain or psychological issues. A strong patient-provider relationship is essential for effective treatment, as it ensures compliance, reduces stigma, and enhances outcomes. Ongoing research promises new treatment options, offering hope for better IBS-C management in the future.

Reference: Sendzischew Shane MA, Ruddy J, Cline M, et al. Review of the Patient Burden and Therapeutic Landscape of Irritable Bowel Syndrome with Constipation in the United States. Clin Exp Gastroenterol. 2024 Aug 2;17:227-253. doi: 10.2147/CEG.S464375. Erratum in: Clin Exp Gastroenterol. 2024 Nov 20;17:347-348. doi: 10.2147/CEG.S506887. PMID: 39114809; PMCID: PMC11303673.

Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder (often more frequent in women) whose prevalence varies by diagnostic criteria and geography. Under Rome IV it’s classified as a disorder of gut-brain interaction and is characterized by recurrent abdominal pain associated with defecation and/or changes in stool frequency or form, after basic evaluation excludes organic disease and alarm features. Patients are grouped by predominant bowel pattern (IBS-D, IBS-C, IBS-M, IBS-U), and symptoms can overlap with other gut-brain interaction disorders. The cause is multifactorial, involving altered gut-brain signaling, visceral hypersensitivity, stress/anxiety, dietary triggers, and shifts in the gut microbiome, so care is usually tailored and multimodal.

Diet is one of the most important—and most challenging—tools in IBS management because responses differ widely from person to person. The review emphasizes that dietary strategies should be individualized, flexible, and ideally supervised to avoid overly restrictive “one-size-fits-all” plans and potential downsides (nutrient gaps, social burden, or disordered eating). Low-FODMAP has the strongest evidence for short-term symptom control and is typically used in phases (restriction, structured reintroduction, personalization). Mediterranean-style patterns may be more sustainable but often require modification for FODMAP sensitivity. Gluten- or lactose-free approaches can help selected subgroups, soluble fiber is often useful (especially in IBS-C), insoluble fiber may worsen symptoms for some, and IgG-guided elimination remains controversial. Overall, the goal is a practical, personalized plan integrated with broader clinical and behavioral support.

Reference: Siragusa N, Baldassari G, Ferrario L, et al. The Ten Dietary Commandments for Patients with Irritable Bowel Syndrome: A Narrative Review with Pragmatic Indications. Nutrients. 2025 Jul 30;17(15):2496. doi: 10.3390/nu17152496. PMID: 40806081; PMCID: PMC12348238.

Irritable bowel syndrome (IBS) is a common functional GI disorder characterized by abdominal pain/discomfort and altered bowel habits without structural or biochemical abnormalities. Its cause is uncertain and likely multifactorial, with psychosocial factors (stress, anxiety/depression, trauma history) often coexisting and amplifying symptoms via the brain–gut axis—contributing to variability and overlap with other functional somatic syndromes (e.g., fibromyalgia, chronic fatigue).

This review emphasizes symptom-based diagnosis using established criteria (Manning/Kruis/Rome, commonly Rome III) while avoiding extensive testing in younger patients without alarm features. Targeted evaluation is reserved for red flags, older patients, and celiac testing in non-constipating IBS. Management is individualized and multimodal: build a strong clinician–patient relationship; address diet/lifestyle (selective elimination diets/FODMAP considerations, soluble fiber like psyllium), exercise, and stress reduction; consider CBT or hypnotherapy; and tailor medications to dominant symptoms (antispasmodics/peppermint oil for pain, TCAs/SSRIs for global symptoms, PEG/secretagogues for IBS-C, loperamide for diarrhea, and alosetron for severe IBS-D with careful risk management). The authors note high placebo response rates and mixed evidence—especially for CAM/probiotics—while highlighting ongoing development of therapies targeting specific mechanisms.

Reference: Saha L. Irritable bowel syndrome: pathogenesis, diagnosis, treatment, and evidence-based medicine. World J Gastroenterol. 2014 Jun 14;20(22):6759-73. doi: 10.3748/wjg.v20.i22.6759. PMID: 24944467; PMCID: PMC4051916.

In a nationwide US survey of more than 70,000 adults, researchers compared how often and how severely lower and upper GI symptoms occur in irritable bowel syndrome with constipation (IBS-C) versus chronic idiopathic constipation (CIC). Adults (≥18 years) completed the NIH GI-PROMIS questionnaire, which uses validated scores to capture symptom frequency and intensity over the prior 7 days. The final analytic sample included 970 eligible respondents (275 IBS-C; 734 CIC). Investigators compared symptom prevalence using adjusted odds ratios and evaluated group differences in PROMIS scores, controlling for demographic differences.

Overall symptom burden was higher in IBS-C than CIC, with significantly higher adjusted global GI-PROMIS scores (251.1 vs 177.8; P<0.001). Abdominal pain stood out as a key differentiator—more common (OR 4.3) and more severe in IBS-C—while constipation severity was also modestly higher in IBS-C. Incontinence was more frequent in IBS-C (OR 2.9) but not more severe. Upper GI symptoms (dysphagia, heartburn, nausea) were similarly prevalent across groups, although heartburn severity was greater in IBS-C. The authors conclude that IBS-C generally has a more severe symptom profile than CIC, but CIC still commonly includes abdominal pain, bloating, and upper GI symptoms.

Reference: Shah ED, Almario CV, Spiegel BMR, Chey WD. Lower and Upper Gastrointestinal Symptoms Differ Between Individuals With Irritable Bowel Syndrome With Constipation or Chronic Idiopathic Constipation. J Neurogastroenterol Motil. 2018 Apr 30;24(2):299-306. doi: 10.5056/jnm17112. PMID: 29605985; PMCID: PMC5885729.

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by abdominal discomfort and altered bowel habits, with a higher prevalence in women. Its subtypes, including irritable bowel syndrome with constipation, are linked to gut microbiota changes, though whether dysbiosis is a cause or consequence remains unclear. Studies show that patients with IBS often exhibit reduced microbial diversity, bacterial overgrowth, and mucosal biofilms, which may disrupt gut barrier function and trigger inflammation. Key microbial metabolites, such as bile acids, short-chain fatty acids, and amino acid derivatives, play important roles in regulating gastrointestinal motility, secretion, and visceral sensitivity—making them potential biomarkers and therapeutic targets.

Microbiota-derived metabolites differ between IBS subtypes and contribute to symptom severity. Neurotransmitters like serotonin and dopamine, regulated in part by gut microbes, are implicated in gut-brain signaling and visceral pain. Amino acid metabolites such as tryptophan derivatives and low fecal hypoxanthine levels may affect intestinal energy balance and epithelial repair. These findings suggest that targeting gut-derived metabolites could guide new diagnostic and treatment strategies for IBS.

Reference: Xiao L, Liu Q, Luo M, et al. Gut Microbiota-Derived Metabolites in Irritable Bowel Syndrome. Front Cell Infect Microbiol. 2021 Sep 23;11:729346. doi: 10.3389/fcimb.2021.729346. PMID: 34631603; PMCID: PMC8495119.

The American College of Gastroenterology's (ACG) 2009 monograph on irritable bowel syndrome (IBS) is an evidence-based update that defines IBS as abdominal pain or discomfort with altered bowel habits for at least 3 months, without structural or biochemical abnormalities. The ACG Task Force on IBS used systematic reviews and a formal grading system (Grade 1/2; evidence levels A–C) to assess diagnostic strategies and treatments. In patients under 50 with typical IBS symptoms and no alarm features, routine extensive testing is not recommended. Instead, limited evaluation plus celiac serology in IBS-D/IBS-M is advised, with colonoscopy reserved for those ≥50 or with alarm features (anemia, weight loss, family history of colorectal cancer/IBD/celiac).

Therapeutically, the review supports psyllium (but not wheat or corn bran) for global IBS symptoms, selected antispasmodics and peppermint oil for short-term pain relief, and loperamide for stool frequency/consistency rather than overall symptom control. Short courses of rifaximin and some nonabsorbable antibiotics benefit IBS-D and bloating, while certain probiotics—especially bifidobacteria or combinations—show modest efficacy. Alosetron (5-HT₃ antagonist) helps severe IBS-D but carries risks of constipation and ischemic colitis. Tegaserod (5-HT₄ agonist) improved IBS-C/M but was withdrawn over cardiovascular concerns. Lubiprostone is effective for IBS-C in women, and both TCAs and SSRIs improve global symptoms and pain across IBS subtypes. Psychological therapies (CBT, dynamic psychotherapy, hypnotherapy) also reduce global symptoms, whereas evidence for exclusion diets, herbal therapies, acupuncture, and SIBO testing is limited or inconsistent.

Top of Form

Reference: American College of Gastroenterology Task Force on Irritable Bowel Syndrome, Brandt LJ, Chey WD, et al. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol. 2009 Jan;104 Suppl 1:S1-35. doi: 10.1038/ajg.2008.122. PMID: 19521341.

Irritable bowel syndrome (IBS) is a common functional GI disorder defined by recurrent abdominal pain with altered bowel habits, diagnosed by Rome IV criteria and classified into IBS-C, IBS-D, IBS-M, and IBS-U. It affects about 4% of the population, is more common in women, and significantly impairs quality of life. Its pathophysiology is heterogeneous, involving altered motility, visceral hypersensitivity, small intestinal bacterial overgrowth, diet, and gut dysbiosis. The gut microbiota—dominated by Firmicutes and Bacteroidetes—supports digestion, immunity, and gut–brain signaling. In IBS-C, studies show altered bacterial profiles and increased methanogens (e.g., Methanobrevibacter smithii), with methane linked to slower transit and more severe constipation.

Management of IBS-C relies heavily on diet and microbiota-focused strategies, but no single “ideal diet” exists. First-line care emphasizes general healthy eating, fluids, exercise, and symptom-targeted changes. Low-FODMAP diets can reduce bloating and global IBS symptoms but have stronger evidence in IBS-D, possible adverse microbiota effects, and uncertain long-term safety. In IBS-C, soluble fibers (psyllium, oats, inulin) can improve stool frequency and consistency, while insoluble fibers may worsen discomfort. Functional foods (kiwi, figs, prunes, linseeds), prebiotics, probiotics, and symbiotics show promising but mixed benefits on constipation, bloating, and quality of life, and fecal microbiota transplantation remains experimental. More high-quality, subtype-specific studies are needed to define optimal nutritional and microbiota-modulating approaches for IBS-C.

8Reference: 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.

A 32-year-old woman presented with persistent gastrointestinal (GI) symptoms, including abdominal pain, bloating, and diarrhea, following a foodborne illness during a trip to Mexico. Despite trying various treatments such as dietary changes (gluten-free, lactose-free, low-FODMAP), medications, and cognitive behavioral therapy, her symptoms persisted. She was diagnosed with irritable bowel syndrome with diarrhea (IBS-D) after negative stool studies, blood work, and a normal colonoscopy. Her symptoms significantly impacted her quality of life, prompting her to seek a second opinion.

The diagnosis of IBS can be challenging due to fluctuating symptoms and overlap with other conditions. Although diagnostic tests are often normal, IBS is primarily diagnosed based on symptom criteria, like those in the Rome IV guidelines, which include recurrent abdominal pain linked to defecation or changes in bowel habits lasting at least six months. Treatment focuses on symptom management through dietary changes, medications like rifaximin, and psychological interventions such as cognitive behavioral therapy. Accurate diagnosis and tailored treatment are essential for improving patient outcomes.

Reference: Lacy BE, Patel NK. Rome Criteria and a Diagnostic Approach to Irritable Bowel Syndrome. J Clin Med. 2017 Oct 26;6(11):99. doi: 10.3390/jcm6110099. PMID: 29072609; PMCID: PMC5704116.

A randomized controlled trial compared the effectiveness of a low FODMAP diet with traditional dietary advice for treating irritable bowel syndrome (IBS). The study included 75 patients meeting the Rome III criteria for IBS, who were randomly assigned to either a low FODMAP diet group (n = 38) or a group following traditional IBS dietary advice (n = 37) for four weeks. Both diets led to significant reductions in IBS symptom severity, with no significant difference in the effectiveness between the two groups. Symptom improvements were measured using the IBS Symptom Severity Scale, and food diaries showed good adherence to the dietary instructions.

The results showed that both dietary approaches effectively reduced IBS symptoms, with 50% of the low-FODMAP group and 46% of the traditional diet group reporting a reduction in IBS severity scores of 50% or more. However, there was no significant difference in the symptom reduction between the groups. The study suggests that while a low-FODMAP diet is effective in managing IBS, traditional IBS dietary advice is equally beneficial. Combining elements from both dietary strategies may offer further improvements in managing IBS symptoms.

Reference: Böhn L, Störsrud S, Liljebo T, et al. Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial. Gastroenterology. 2015 Nov;149(6):1399-1407.e2. doi: 10.1053/j.gastro.2015.07.054. Epub 2015 Aug 5. PMID: 26255043.