Irritable bowel syndrome

This article is about the functional disorder. For bowel inflammation, see inflammatory bowel disease. For other uses, see IBS (disambiguation).

Irritable bowel syndrome
Other namesSpastic colon, nervous colon, mucous colitis, spastic bowel[1]
3D depiction of the pain of IBS
SpecialtyGastroenterology
SymptomsDiarrhea, constipation, abdominal pain[1]
Usual onsetBefore 45 years old[1]
DurationLong term[2]
CausesUnknown[2]
Risk factorsGenetic predisposition,[3] psychological stress,[4]
childhood abuse,
food poisoning,[5]
psychiatric illness[6]
Diagnostic methodBased on symptoms, exclusion of other diseases[7]
Differential diagnosisCeliac disease, giardiasis, non-celiac gluten sensitivity, microscopic colitis, inflammatory bowel disease, small intestine bacterial overgrowth, bile acid malabsorption, colon cancer[7][8]
TreatmentSymptomatic (dietary changes, medication, human milk oligosaccharides, probiotics, counseling)[9]
PrognosisNormal life expectancy[10]
Frequency10–15% (developed world)[1][11] and 15–45% (globally)[12]

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by a group of symptoms that commonly include abdominal pain, abdominal bloating and changes in the consistency of bowel movements.[1] These symptoms may occur over a long time, sometimes for years.[2] IBS can negatively affect quality of life and may result in missed school or work or reduced productivity at work.[13] Disorders such as anxiety, major depression, and chronic fatigue syndrome are common among people with IBS.[1][14][note 1][15]

The cause of IBS is not known but multiple factors have been proposed to lead to the condition.[2] Theories include combinations of "gut–brain axis" problems, alterations in gut motility, visceral hypersensitivity, infections including small intestinal bacterial overgrowth, neurotransmitters, genetic factors, and food sensitivity.[2] Onset may be triggered by a stressful life event,[16] or an intestinal infection.[17] In the latter case, it is called post-infectious irritable bowel syndrome.[17]

Diagnosis is based on symptoms in the absence of worrisome features and once other potential conditions have been ruled out.[7] Worrisome or "alarm" features include onset at greater than 50 years of age, weight loss, blood in the stool, or a family history of inflammatory bowel disease.[7] Other conditions that may present similarly include celiac disease, microscopic colitis, inflammatory bowel disease, bile acid malabsorption, and colon cancer.[7]

Treatment of IBS is carried out to improve symptoms. This may include dietary changes, medication, probiotics, and counseling.[9][18] Dietary measures include increasing soluble fiber intake, or a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs). The "low FODMAP" diet is meant for short to medium term use and is not intended as a life-long therapy.[7][19][20] The medication loperamide may be used to help with diarrhea while laxatives may be used to help with constipation.[7] There is strong clinical-trial evidence for the use of antidepressants, often in lower doses than that used for depression or anxiety, even in patients without comorbid mood disorder. Tricyclic antidepressants such as amitriptyline or nortriptyline and medications from the selective serotonin reuptake inhibitor (SSRI) group may improve overall symptoms and reduce pain.[7] Patient education and a good doctor–patient relationship are an important part of care.[7][21]

About 10–15% of people in the developed world are believed to be affected by IBS.[1][11] The prevalence varies according to country (from 1.1% to 45.0%) and criteria used to define IBS; however the average global prevalence is 11.2%.[12] It is more common in South America and less common in Southeast Asia.[7] In the Western world, it is twice as common in women as men and typically occurs before age 45.[1] However, women in East Asia are not more likely than their male counterparts to have IBS, indicating much lower rates among East Asian women.[22] Similarly, men from South America, South Asia and Africa are just as likely to have IBS as women in those regions, if not more so.[23] The condition appears to become less common with age.[7] IBS does not affect life expectancy or lead to other serious diseases.[10] The first description of the condition was in 1820, while the current term irritable bowel syndrome came into use in 1944.[24]

  1. ^ a b c d e f g h "Definition and Facts for Irritable Bowel Syndrome". NIDDKD. February 23, 2015. Archived from the original on April 2, 2016. Retrieved March 29, 2016.
  2. ^ a b c d e "Symptoms and Causes of Irritable Bowel Syndrome". NIDDK. February 23, 2015. Archived from the original on April 5, 2016. Retrieved March 29, 2016.
  3. ^ Li J, Zhu W, Liu W, Wu Y, Wu B (January 2016). "Rifaximin for Irritable Bowel Syndrome: A Meta-Analysis of Randomized Placebo-Controlled Trials". Medicine. 95 (4): e2534. doi:10.1097/MD.0000000000002534. PMC 5291563. PMID 26825893.
  4. ^ Fukudo S, Nomura T, Muranaka M, Taguchi F (September 1993). "Brain-gut response to stress and cholinergic stimulation in irritable bowel syndrome. A preliminary study". Journal of Clinical Gastroenterology. 17 (2): 133–41. doi:10.1097/00004836-199309000-00009. PMID 8031340.
  5. ^ "Post Infectious IBS - About IBS". March 8, 2021.
  6. ^ Barreau F, Ferrier L, Fioramonti J, Bueno L (September 2007). "New insights in the etiology and pathophysiology of irritable bowel syndrome: contribution of neonatal stress models". Pediatric Research. 62 (3): 240–5. doi:10.1203/PDR.0b013e3180db2949. PMID 17622962. S2CID 26538682.
  7. ^ a b c d e f g h i j k Chey WD, Kurlander J, Eswaran S (March 2015). "Irritable bowel syndrome: a clinical review". JAMA. 313 (9): 949–58. doi:10.1001/jama.2015.0954. PMID 25734736. S2CID 205062386.
  8. ^ Cite error: The named reference LevyBernstein2014 was invoked but never defined (see the help page).
  9. ^ a b "Treatment for Irritable Bowel Syndrome". NIDDK. February 23, 2015. Archived from the original on April 6, 2016. Retrieved March 29, 2016.
  10. ^ a b Quigley EM (2013). "Treatment level 1". Irritable Bowel Syndrome: Diagnosis and Clinical Management (First ed.). Chichester, West Sussex: Wiley-Blackwell. ISBN 978-1-118-44474-0. Archived from the original on September 8, 2017.
  11. ^ a b Maxion-Bergemann S, Thielecke F, Abel F, Bergemann R (2006). "Costs of irritable bowel syndrome in the UK and US". PharmacoEconomics. 24 (1): 21–37. doi:10.2165/00019053-200624010-00002. PMID 16445300. S2CID 45376327.
  12. ^ a b Lovell RM, Ford AC (July 2012). "Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis". Clinical Gastroenterology and Hepatology. 10 (7): 712–721.e4. doi:10.1016/j.cgh.2012.02.029. PMID 22426087. Pooled prevalence in all studies was 11.2% (95% CI, 9.8%-12.8%). The prevalence varied according to country (from 1.1% to 45.0%) and criteria used to define IBS... Women are at slightly higher risk for IBS than men.
  13. ^ Hulisz D (2004). "The burden of illness of irritable bowel syndrome: current challenges and hope for the future". Journal of Managed Care Pharmacy. 10 (4): 299–309. doi:10.18553/jmcp.2004.10.4.299. PMC 10437478. PMID 15298528. S2CID 9413379.
  14. ^ Whitehead WE, Palsson O, Jones KR (April 2002). "Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications?". Gastroenterology. 122 (4): 1140–56. doi:10.1053/gast.2002.32392. PMID 11910364.
  15. ^ "Irritable bowel syndrome - Symptoms and causes". Mayo Clinic. Retrieved December 5, 2023.
  16. ^ Chang L (March 2011). "The role of stress on physiologic responses and clinical symptoms in irritable bowel syndrome". Gastroenterology. 140 (3): 761–5. doi:10.1053/j.gastro.2011.01.032. PMC 3039211. PMID 21256129.
  17. ^ a b Spiller R, Garsed K (May 2009). "Postinfectious irritable bowel syndrome". Gastroenterology. 136 (6): 1979–88. doi:10.1053/j.gastro.2009.02.074. PMID 19457422.
  18. ^ Palsson OS, Peery A, Seitzberg D, Amundsen ID, McConnell B, Simrén M (December 2020). "Human Milk Oligosaccharides Support Normal Bowel Function and Improve Symptoms of Irritable Bowel Syndrome: A Multicenter, Open-Label Trial". Clinical and Translational Gastroenterology. 11 (12): e00276. doi:10.14309/ctg.0000000000000276. PMC 7721220. PMID 33512807.
  19. ^ Moayyedi P, Quigley EM, Lacy BE, Lembo AJ, Saito YA, Schiller LR, et al. (September 2014). "The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis". The American Journal of Gastroenterology. 109 (9): 1367–1374. doi:10.1038/ajg.2014.195. PMID 25070054. S2CID 8076372.
  20. ^ Cite error: The named reference Rao2015 was invoked but never defined (see the help page).
  21. ^ Mayer EA (April 2008). "Clinical practice. Irritable bowel syndrome". The New England Journal of Medicine. 358 (16): 1692–1699. doi:10.1056/NEJMcp0801447. PMC 3816529. PMID 18420501.
  22. ^ Jung HK (April 2011). "Is there true gender difference of irritable bowel syndrome in Asia?". Journal of Neurogastroenterology and Motility. 17 (2): 206–207. doi:10.5056/jnm.2011.17.2.206. PMC 3093021. PMID 21603006. "However, some Asian studies fail to report significant gender differences in the prevalence of IBS.6"
  23. ^ Canavan C, West J, Card T (February 4, 2014). "The epidemiology of irritable bowel syndrome". Clinical Epidemiology. 6: 71–80. doi:10.2147/CLEP.S40245. PMC 3921083. PMID 24523597. "In South Asia, South America, and Africa, rates of IBS in men are much closer to those of women, and in some cases higher. Consequently, if prevalence is stratified according to geographic region, no significant sex difference can be seen in these areas.80"
  24. ^ Hatch MC (2000). Women and Health. San Diego, Calif: Academic Press. p. 1098. ISBN 978-0-12-288145-9. Archived from the original on September 8, 2017.


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