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.

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 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.

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.

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.

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.

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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.

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.

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.

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.

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

In this review, pharmaceutical treatment options are unaccounted for. Consensus groups and meta-analyses have designed guidelines that are similar, with variations in the strength of recommendations and some cultural and geographical particularities. IBS-C diagnosis relies on clinical criteria like the Rome IV criteria, and treatment typically begins with dietary changes. 

Studies show that a diet with FODMAPs affects bloating, abdominal pain, and other IBS symptoms, thus, the low FODMAP diet, as well as the modified National Institute of Clinical Excellence (NICE) diet, can offer symptom relief by reducing fermentable carbohydrates that cause bloating and discomfort. While gluten- and lactose-free diets are sometimes tried, evidence for their effectiveness in IBS is limited. Overall, individualized dietary and lifestyle interventions remain central to managing IBS symptoms.

Reference: Galica AN, Galica R, Dumitrașcu DL. Diet, fibers, and probiotics for irritable bowel syndrome. J Med Life. 2022 Feb;15(2):174-179. doi: 10.25122/jml-2022-0028. PMID: 35419092; PMCID: PMC8999090.

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 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.

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.

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.

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 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.

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 (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/

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.

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.

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.