Diagnosis and Treatment of Irritable Bowel Syndrome | Gastroenterology | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

Diagnosis and Treatment of Irritable Bowel SyndromeA Review

Educational Objective
To review the clinical management of patients with irritable bowel syndrome.
1 Credit CME
Abstract

Importance  The prevalence of irritable bowel syndrome (IBS) in the United States is between 7% and 16%, most common in women and young people, with annual direct costs estimated at more than $1 billion dollars in the United States. Traditionally, the diagnosis of IBS has been based on the positive identification of symptoms that correlate with several different syndromes associated with disorders such as IBS diarrhea, IBS constipation, functional diarrhea, functional constipation, chronic functional abdominal pain, or bloating. Several peripheral and central mechanisms initiate gastrointestinal motor and sensory dysfunctions leading to IBS symptoms. Those dysfunctions may require evaluation in patients whose symptoms do not respond to first-line treatments.

Observations  Validation studies of consensus symptom-based criteria have identified deficiencies that favor a simpler identification of the predominant symptoms of abdominal pain, bowel dysfunction, and bloating and exclusion of alarm symptoms such as unintentional weight loss, rectal bleeding, or recent change in bowel function. Symptom-based diagnosis of IBS is enhanced with additional history for symptoms of somatoform and psychological disorders and alarm symptoms, physical examination including digital rectal examination, and screening tests to exclude organic disease (by measuring hemoglobin and C-reactive protein concentrations). The initial treatment plan should include patient education, reassurance, and first-line treatments such as fiber and osmotic laxatives for constipation, opioids for diarrhea, antispasmodics for pain and for management of associated psychological disorders. For patients who do not respond to those IBS treatments, testing for specific functional disorders may be required in a minority of patients with IBS. These disorders include rectal evacuation disorder, abnormal colonic transit, and bile acid diarrhea. Their identification is followed by individualized treatment, such as pelvic floor retraining for rectal evacuation disorders, sequestrants for bile acid diarrhea, and secretory agents for constipation, although there is only limited evidence that this individualized management approach is effective.

Conclusions and Relevance  Advances in the identification of specific dysfunctions as causes of individual symptoms in the “IBS spectrum” leads to the potential to enhance the diagnosis and management of symptoms for the majority of patients for whom first-line therapies of IBS and management of comorbid psychological disorders are insufficient.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

Corresponding Author: Michael Camilleri, MD, Mayo Clinic, 200 First St SW, Charlton Bldg, Room 8-110, Rochester, MN 55905 (camilleri.michael@mayo.edu).

Correction: This article was corrected online April 20, 2021, to include a decimal point to describe the number of endoscopic procedures that were reported in an article cited in the Laboratory Evaluation subsection.

Accepted for Publication: October 28, 2020.

Conflict of Interest Disclosures: Dr Camilleri reported receiving grants from the National Institutes of Health, Allergan, the International Life Sciences Institute, Arena, and Vandra and receiving institutional support for being an advisor to Allergan, Takeda, and Ironwood.

Author Contributions: Dr Camilleri had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Funding/Support: Dr Camilleri is supported by grant R01-DK115950 from the National Institutes of Health.

References
1.
Mearin  F , Lacy  BE , Chang  L ,  et al.  Bowel disorders.   Gastroenterology. 2016;150(6):1393-1407.e5. doi:10.1053/j.gastro.2016.02.031 PubMedGoogle ScholarCrossref
2.
Sperber  AD , Bangdiwala  SI , Drossman  DA ,  et al.  Worldwide prevalence and burden of functional gastrointestinal disorders, results of Rome Foundation global study.   Gastroenterology. 2021;160(1):99-114.e3. doi:10.1053/j.gastro.2020.04.014 PubMedGoogle ScholarCrossref
3.
Peery  AF , Crockett  SD , Murphy  CC ,  et al.  Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: update 2018.   Gastroenterology. 2019;156(1):254-272.e11. doi:10.1053/j.gastro.2018.08.063 PubMedGoogle ScholarCrossref
4.
Oka  P , Parr  H , Barberio  B , Black  CJ , Savarino  EV , Ford  AC .  Global prevalence of irritable bowel syndrome according to Rome III or IV criteria: a systematic review and meta-analysis.   Lancet Gastroenterol Hepatol. 2020;5(10):908-917. doi:10.1016/S2468-1253(20)30217-X PubMedGoogle ScholarCrossref
5.
Drossman  DA , Li  Z , Andruzzi  E ,  et al.  US householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact.   Dig Dis Sci. 1993;38(9):1569-1580. doi:10.1007/BF01303162 PubMedGoogle ScholarCrossref
6.
Camilleri  M .  Peripheral mechanisms in irritable bowel syndrome.   N Engl J Med. 2012;367(17):1626-1635. doi:10.1056/NEJMra1207068 PubMedGoogle ScholarCrossref
7.
Williams  RE , Black  CL , Kim  H-Y ,  et al.  Determinants of healthcare-seeking behaviour among subjects with irritable bowel syndrome.   Aliment Pharmacol Ther. 2006;23(11):1667-1675. doi:10.1111/j.1365-2036.2006.02928.x PubMedGoogle ScholarCrossref
8.
Thompson  WG , Dotevall  G , Drossman  DA , Heaton  KW , Kruis  W .  Irritable bowel syndrome (guidelines for the diagnosis).   Gastroenterol Int. 1989;2:92-95.Google Scholar
9.
Thompson  WG , Longstreth  GF , Drossman  DA , Heaton  KW , Irvine  EJ , Müller-Lissner  SA .  Functional bowel disorders and functional abdominal pain.   Gut. 1999;45(suppl 2):II43-II47. doi:10.1136/gut.45.2008.ii43 PubMedGoogle Scholar
10.
Longstreth  GF , Thompson  WG , Chey  WD , Houghton  LA , Mearin  F , Spiller  RC .  Functional bowel disorders.   Gastroenterology. 2006;130(5):1480-1491. doi:10.1053/j.gastro.2005.11.061 PubMedGoogle ScholarCrossref
11.
Lacy  BE , Mearin  F , Chang  L , Chey  WD , Lembo  AJ , Simren  M .  Bowel disorders.   Gastroenterology. 2016;150(6):1393-1407.e5. doi:10.1053/j.gastro.2016.02.031Google ScholarCrossref
12.
Camilleri  M .  Irritable bowel syndrome: straightening the road from the Rome criteria.   Neurogastroenterol Motil. 2020;32(11):e13957. doi:10.1111/nmo.13957 PubMedGoogle Scholar
13.
Lin  L , Chang  L .  Benefits and pitfalls of change from Rome III to Rome IV criteria for irritable bowel syndrome and fecal incontinence.   Clin Gastroenterol Hepatol. 2020;18(2):297-299. doi:10.1016/j.cgh.2019.10.004 PubMedGoogle ScholarCrossref
14.
Sood  R , Camilleri  M , Gracie  DJ ,  et al.  Enhancing diagnostic performance of symptom-based criteria for irritable bowel syndrome by additional history and limited diagnostic evaluation.   Am J Gastroenterol. 2016;111(10):1446-1454. doi:10.1038/ajg.2016.308 PubMedGoogle ScholarCrossref
15.
Wolf  AMD , Fontham  ETH , Church  TR ,  et al.  Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society.   CA Cancer J Clin. 2018;68(4):250-281. doi:10.3322/caac.21457 PubMedGoogle ScholarCrossref
16.
Lin  JS , Piper  MA , Perdue  LA ,  et al.  Screening for colorectal cancer: updated evidence report and systematic review for the US Preventive Services Task Force.   JAMA. 2016;315(23):2576-2594. doi:10.1001/jama.2016.3332 PubMedGoogle ScholarCrossref
17.
Knudsen  AB , Zauber  AG , Rutter  CM ,  et al.  Estimation of benefits, burden, and harms of colorectal cancer screening strategies: modeling study for the US Preventive Services Task Force.   JAMA. 2016;315(23):2595-2609. doi:10.1001/jama.2016.6828 PubMedGoogle ScholarCrossref
18.
Locke  GR  III , Zinsmeister  AR , Fett  SL , Melton  LJ  III , Talley  NJ .  Overlap of gastrointestinal symptom complexes in a US community.   Neurogastroenterol Motil. 2005;17(1):29-34. doi:10.1111/j.1365-2982.2004.00581.x PubMedGoogle ScholarCrossref
19.
Halder  SL , Locke  GR  III , Schleck  CD , Zinsmeister  AR , Melton  LJ  III , Talley  NJ .  Natural history of functional gastrointestinal disorders: a 12-year longitudinal population-based study.   Gastroenterology. 2007;133(3):799-807. doi:10.1053/j.gastro.2007.06.010 PubMedGoogle ScholarCrossref
20.
Palsson  OS , Whitehead  W , Törnblom  H , Sperber  AD , Simren  M .  Prevalence of Rome IV functional bowel disorders among adults in the United States, Canada, and the United Kingdom.   Gastroenterology. 2020;158(5):1262-1273.e3. doi:10.1053/j.gastro.2019.12.021 PubMedGoogle ScholarCrossref
21.
Singh  P , Lee  HN , Rangan  V ,  et al.  Similarities in clinical and psychosocial characteristics of functional diarrhea and irritable bowel syndrome with diarrhea.   Clin Gastroenterol Hepatol. 2020;18(2):399-405.e1. doi:10.1016/j.cgh.2019.08.020 PubMedGoogle ScholarCrossref
22.
Brandler  J , Camilleri  M .  Pretest and posttest probabilities of diagnoses of rectal evacuation disorders based on symptoms, rectal exam, and basic tests: a systematic review.   Clin Gastroenterol Hepatol. 2020;18(11):2479-2490. doi:10.1016/j.cgh.2019.11.049 PubMedGoogle ScholarCrossref
23.
Tantiphlachiva  K , Rao  P , Attaluri  A , Rao  SS .  Digital rectal examination is a useful tool for identifying patients with dyssynergia.   Clin Gastroenterol Hepatol. 2010;8(11):955-960. doi:10.1016/j.cgh.2010.06.031 PubMedGoogle ScholarCrossref
24.
Lembo  A , Camilleri  M .  Chronic constipation.   N Engl J Med. 2003;349(14):1360-1368. doi:10.1056/NEJMra020995 PubMedGoogle ScholarCrossref
25.
Chedid  V , Vijayvargiya  P , Halawi  H , Park  SY , Camilleri  M .  Audit of the diagnosis of rectal evacuation disorders in chronic constipation.   Neurogastroenterol Motil. 2019;31(1):e13510. doi:10.1111/nmo.13510 PubMedGoogle Scholar
26.
Liu  A , Chedid  V , Wang  XJ , Vijayvargiya  P , Camilleri  M .  Clinical presentation and characteristics of pelvic floor myofascial pain in patients presenting with constipation.   Neurogastroenterol Motil. 2020;32(7):e13845. doi:10.1111/nmo.13845 PubMedGoogle Scholar
27.
Irvine  AJ , Chey  WD , Ford  AC .  Screening for celiac disease in irritable bowel syndrome: an updated systematic review and meta-analysis.   Am J Gastroenterol. 2017;112(1):65-76. doi:10.1038/ajg.2016.466 PubMedGoogle ScholarCrossref
28.
Atieh  J , Chedid  V , Khoshbin  K , Kane  S , Camilleri  M .  Development of a score to predict positive colonic histology in chronic diarrhea assessed in open-access colonoscopy.   J Clin Gastroenterol. Published online August 21, 2020. doi:10.1097/MCG.0000000000001414 PubMedGoogle Scholar
29.
Vijayvargiya  P , Gonzalez Izundegui  D , Calderon  G , Tawfic  S , Batbold  S , Camilleri  M .  Fecal bile acid testing in assessing patients with chronic unexplained diarrhea: implications for healthcare utilization.   Am J Gastroenterol. 2020;115(7):1094-1102. doi:10.14309/ajg.0000000000000637PubMedGoogle ScholarCrossref
30.
Camilleri  M , Chedid  V .  Actionable biomarkers: the key to resolving disorders of gastrointestinal function.   Gut. 2020;69(10):1730-1737. doi:10.1136/gutjnl-2019-320325 PubMedGoogle ScholarCrossref
31.
Chey  WD , Nojkov  B , Rubenstein  JH , Dobhan  RR , Greenson  JK , Cash  BD .  The yield of colonoscopy in patients with non-constipated irritable bowel syndrome: results from a prospective, controlled US trial.   Am J Gastroenterol. 2010;105(4):859-865. doi:10.1038/ajg.2010.55 PubMedGoogle ScholarCrossref
32.
Williams  R , White  P , Nieto  J , Vieira  D , Francois  F , Hamilton  F .  Colorectal cancer in African Americans: an update.   Clin Transl Gastroenterol. 2016;7(7):e185. doi:10.1038/ctg.2016.36 PubMedGoogle Scholar
33.
Drossman  DA , Ruddy  J .  Improving patient-provider relationships to improve health care.   Clin Gastroenterol Hepatol. 2020;18(7):1417-1426. doi:10.1016/j.cgh.2019.12.007 PubMedGoogle ScholarCrossref
34.
Johannesson  E , Simrén  M , Strid  H , Bajor  A , Sadik  R .  Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial.   Am J Gastroenterol. 2011;106(5):915-922. doi:10.1038/ajg.2010.480 PubMedGoogle ScholarCrossref
35.
Johannesson  E , Ringström  G , Abrahamsson  H , Sadik  R .  Intervention to increase physical activity in irritable bowel syndrome shows long-term positive effects.   World J Gastroenterol. 2015;21(2):600-608. doi:10.3748/wjg.v21.i2.600 PubMedGoogle ScholarCrossref
36.
Shahabi  L , Naliboff  BD , Shapiro  D .  Self-regulation evaluation of therapeutic yoga and walking for patients with irritable bowel syndrome: a pilot study.   Psychol Health Med. 2016;21(2):176-188. doi:10.1080/13548506.2015.1051557 PubMedGoogle ScholarCrossref
37.
Camilleri  M , McKinzie  S , Busciglio  I ,  et al.  Prospective study of motor, sensory, psychologic, and autonomic functions in patients with irritable bowel syndrome.   Clin Gastroenterol Hepatol. 2008;6(7):772-781. doi:10.1016/j.cgh.2008.02.060 PubMedGoogle ScholarCrossref
38.
Keefer  L , Drossman  DA , Guthrie  E ,  et al.  Centrally mediated disorders of gastrointestinal pain.   Gastroenterology. 2016;150(6):1408-1419. doi:10.1053/j.gastro.2016.02.034 PubMedGoogle ScholarCrossref
39.
Drossman  DA , Tack  J , Ford  AC , Szigethy  E , Törnblom  H , Van Oudenhove  L .  Neuromodulators for functional gastrointestinal disorders (disorders of gut-brain interaction): a Rome Foundation working team report.   Gastroenterology. 2018;154(4):1140-1171.e1. doi:10.1053/j.gastro.2017.11.279 PubMedGoogle ScholarCrossref
40.
Tack  J , Corsetti  M , Camilleri  M ,  et al.  Plausibility criteria for putative pathophysiological mechanisms in functional gastrointestinal disorders: a consensus of experts.   Gut. 2018;67(8):1425-1433. doi:10.1136/gutjnl-2016-312230 PubMedGoogle ScholarCrossref
41.
Metcalf  AM , Phillips  SF , Zinsmeister  AR , MacCarty  RL , Beart  RW , Wolff  BG .  Simplified assessment of segmental colonic transit.   Gastroenterology. 1987;92(1):40-47. doi:10.1016/0016-5085(87)90837-7 PubMedGoogle ScholarCrossref
42.
Törnblom  H , Van Oudenhove  L , Sadik  R , Abrahamsson  H , Tack  J , Simrén  M .  Colonic transit time and IBS symptoms: what’s the link?   Am J Gastroenterol. 2012;107(5):754-760. doi:10.1038/ajg.2012.5 PubMedGoogle ScholarCrossref
43.
Simrén  M , Törnblom  H , Palsson  OS , Van Oudenhove  L , Whitehead  WE , Tack  J .  Cumulative effects of psychologic distress, visceral hypersensitivity, and abnormal transit on patient-reported outcomes in irritable bowel syndrome.   Gastroenterology. 2019;157(2):391-402.e2. doi:10.1053/j.gastro.2019.04.019 PubMedGoogle ScholarCrossref
44.
Manabe  N , Wong  BS , Camilleri  M , Burton  D , McKinzie  S , Zinsmeister  AR .  Lower functional gastrointestinal disorders: evidence of abnormal colonic transit in a 287 patient cohort.   Neurogastroenterol Motil. 2010;22(3):293-e82. doi:10.1111/j.1365-2982.2009.01442.x PubMedGoogle ScholarCrossref
45.
Nullens  S , Nelsen  T , Camilleri  M ,  et al.  Regional colon transit in patients with dys-synergic defaecation or slow transit in patients with constipation.   Gut. 2012;61(8):1132-1139. doi:10.1136/gutjnl-2011-301181 PubMedGoogle ScholarCrossref
46.
Camilleri  M , Thorne  NK , Ringel  Y ,  et al.  Wireless pH-motility capsule for colonic transit: prospective comparison with radiopaque markers in chronic constipation.   Neurogastroenterol Motil. 2010;22(8):874-882, e233. doi:10.1111/j.1365-2982.2010.01517.x PubMedGoogle ScholarCrossref
47.
Carrington  EV , Scott  SM , Bharucha  A ,  et al; International Anorectal Physiology Working Group and the International Working Group for Disorders of Gastrointestinal Motility and Function.  Expert consensus document: advances in the evaluation of anorectal function.   Nat Rev Gastroenterol Hepatol. 2018;15(5):309-323. doi:10.1038/nrgastro.2018.27 PubMedGoogle ScholarCrossref
48.
Park  SY , Khemani  D , Nelson  AD , Eckert  D , Camilleri  M .  Rectal gas volume measured by computerized tomography identifies evacuation disorders in patients with constipation.   Clin Gastroenterol Hepatol. 2017;15(4):543-552.e4. doi:10.1016/j.cgh.2016.11.013 PubMedGoogle ScholarCrossref
49.
Park  SY , Khemani  D , Acosta  A , Eckert  D , Camilleri  M .  Rectal gas volume: defining cut-offs for screening for evacuation disorders in patients with constipation.   Neurogastroenterol Motil. 2017;29(7). doi:10.1111/nmo.13044 PubMedGoogle Scholar
50.
Shim  L , Prott  G , Hansen  RD , Simmons  LE , Kellow  JE , Malcolm  A .  Prolonged balloon expulsion is predictive of abdominal distension in bloating.   Am J Gastroenterol. 2010;105(4):883-887. doi:10.1038/ajg.2010.54 PubMedGoogle ScholarCrossref
51.
Cangemi  DJ , Flanagan  R , Barshop  K , Kuo  B , Staller  K .  Colonic stool burden a useful surrogate for slow transit constipation as determined by a radiopaque transit study.   Am J Gastroenterol. 2019;114(3):519-523. doi:10.14309/ajg.0000000000000149 PubMedGoogle ScholarCrossref
52.
Lactose intolerance. MedlinePlus. Updated August 18, 2020. Accessed October 23, 2020. https://medlineplus.gov/genetics/condition/lactose-intolerance
53.
Micic  D , Rao  VL , Rubin  DT .  Clinical approach to lactose intolerance.   JAMA. 2019;322(16):1600-1601. doi:10.1001/jama.2019.14740 PubMedGoogle ScholarCrossref
54.
Garcia-Etxebarria  K , Zheng  T , Bonfiglio  F ,  et al.  Increased prevalence of rare sucrase-isomaltase pathogenic variants in irritable bowel syndrome patients.   Clin Gastroenterol Hepatol. 2018;16(10):1673-1676. doi:10.1016/j.cgh.2018.01.047 PubMedGoogle ScholarCrossref
55.
Suarez  FL , Savaiano  DA , Levitt  MD .  A comparison of symptoms after the consumption of milk or lactose-hydrolyzed milk by people with self-reported severe lactose intolerance.   N Engl J Med. 1995;333(1):1-4. doi:10.1056/NEJM199507063330101 PubMedGoogle ScholarCrossref
56.
Valentin  N , Camilleri  M , Altayar  O ,  et al.  Biomarkers for bile acid diarrhoea in functional bowel disorder with diarrhoea: a systematic review and meta-analysis.   Gut. 2016;65(12):1951-1959. doi:10.1136/gutjnl-2015-309889 PubMedGoogle ScholarCrossref
57.
Vijayvargiya  P , Camilleri  M .  Commentary: current practice in the diagnosis of bile acid diarrhea.   Gastroenterology. 2019;156(5):1233-1238. doi:10.1053/j.gastro.2018.11.069 PubMedGoogle ScholarCrossref
58.
Aziz  I , Törnblom  H , Simrén  M .  Small intestinal bacterial overgrowth as a cause for irritable bowel syndrome: guilty or not guilty?   Curr Opin Gastroenterol. 2017;33(3):196-202. doi:10.1097/MOG.0000000000000348 PubMedGoogle ScholarCrossref
59.
Pimentel  M , Saad  RJ , Long  MD , Rao  SSC .  ACG clinical guideline: small intestinal bacterial overgrowth.   Am J Gastroenterol. 2020;115(2):165-178. doi:10.14309/ajg.0000000000000501 PubMedGoogle ScholarCrossref
60.
Yu  D , Cheeseman  F , Vanner  S .  Combined oro-caecal scintigraphy and lactulose hydrogen breath testing demonstrate that breath testing detects oro-caecal transit, not small intestinal bacterial overgrowth in patients with IBS.   Gut. 2011;60(3):334-340. doi:10.1136/gut.2009.205476 PubMedGoogle ScholarCrossref
61.
Posserud  I , Stotzer  PO , Björnsson  ES , Abrahamsson  H , Simrén  M .  Small intestinal bacterial overgrowth in patients with irritable bowel syndrome.   Gut. 2007;56(6):802-808. doi:10.1136/gut.2006.108712 PubMedGoogle ScholarCrossref
62.
Pimentel  M , Lembo  A , Chey  WD ,  et al; TARGET Study Group.  Rifaximin therapy for patients with irritable bowel syndrome without constipation.   N Engl J Med. 2011;364(1):22-32. doi:10.1056/NEJMoa1004409 PubMedGoogle ScholarCrossref
63.
Rao  SS , Seaton  K , Miller  M ,  et al.  Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation.   Clin Gastroenterol Hepatol. 2007;5(3):331-338. doi:10.1016/j.cgh.2006.12.023 PubMedGoogle ScholarCrossref
64.
Heymen  S , Scarlett  Y , Jones  K , Ringel  Y , Drossman  D , Whitehead  WE .  Randomized, controlled trial shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia-type constipation.   Dis Colon Rectum. 2007;50(4):428-441. doi:10.1007/s10350-006-0814-9 PubMedGoogle ScholarCrossref
65.
Rao  SS , Valestin  J , Brown  CK , Zimmerman  B , Schulze  K .  Long-term efficacy of biofeedback therapy for dyssynergic defecation: randomized controlled trial.   Am J Gastroenterol. 2010;105(4):890-896. doi:10.1038/ajg.2010.53 PubMedGoogle ScholarCrossref
66.
Chiarioni  G , Nardo  A , Vantini  I , Romito  A , Whitehead  WE .  Biofeedback is superior to electrogalvanic stimulation and massage for treatment of levator ani syndrome.   Gastroenterology. 2010;138(4):1321-1329. doi:10.1053/j.gastro.2009.12.040 PubMedGoogle ScholarCrossref
67.
Farid  M , El Monem  HA , Omar  W ,  et al.  Comparative study between biofeedback retraining and botulinum neurotoxin in the treatment of anismus patients.   Int J Colorectal Dis. 2009;24(1):115-120. doi:10.1007/s00384-008-0567-0 PubMedGoogle ScholarCrossref
68.
Vijayvargiya  P , Camilleri  M , Carlson  P ,  et al.  Effects of colesevelam on bowel symptoms, biomarkers, and colonic mucosal gene expression in patients with bile acid diarrhea in a randomized trial.   Clin Gastroenterol Hepatol. 2020;18(13):2962-2970.e6. doi:10.1016/j.cgh.2020.02.027 PubMedGoogle ScholarCrossref
69.
Ford  AC , Moayyedi  P , Chey  WD ,  et al; ACG Task Force on Management of Irritable Bowel Syndrome.  American College of Gastroenterology monograph on management of irritable bowel syndrome.   Am J Gastroenterol. 2018;113(suppl 2):1-18. doi:10.1038/s41395-018-0084-x PubMedGoogle ScholarCrossref
70.
Black  CJ , Yuan  Y , Selinger  CP ,  et al.  Efficacy of soluble fibre, antispasmodic drugs, and gut-brain neuromodulators in irritable bowel syndrome: a systematic review and network meta-analysis.   Lancet Gastroenterol Hepatol. 2020;5(2):117-131. doi:10.1016/S2468-1253(19)30324-3 PubMedGoogle ScholarCrossref
71.
Bijkerk  CJ , de Wit  NJ , Muris  JW , Whorwell  PJ , Knottnerus  JA , Hoes  AW .  Soluble or insoluble fibre in irritable bowel syndrome in primary care? randomised placebo controlled trial.   BMJ. 2009;339:b3154. doi:10.1136/bmj.b3154 PubMedGoogle ScholarCrossref
72.
National Institute for Health and Care Excellence. Addendum to NICE guideline CG61, irritable bowel syndrome in adults: diagnosis and management of irritable bowel syndrome in primary care. February 2015. Accessed October 23, 2020. https://www.nice.org.uk/guidance/cg61/evidence/addendum-pdf-7081259797
73.
Wang  XJ , Camilleri  M , Vanner  S , Tuck  C .  Review article: biological mechanisms for symptom causation by individual FODMAP subgroups—the case for a more personalised approach to dietary restriction.   Aliment Pharmacol Ther. 2019;50(5):517-529. doi:10.1111/apt.15419 PubMedGoogle ScholarCrossref
74.
Massey  BT , Wald  A .  Small intestinal bacterial overgrowth syndrome: a guide for the appropriate use of breath testing.   Dig Dis Sci. 2021;66(2):338-347. doi:10.1007/s10620-020-06623-6PubMedGoogle ScholarCrossref
75.
Storhaug  CL , Fosse  SK , Fadnes  LT .  Country, regional, and global estimates for lactose malabsorption in adults: a systematic review and meta-analysis.   Lancet Gastroenterol Hepatol. 2017;2(10):738-746. doi:10.1016/S2468-1253(17)30154-1 PubMedGoogle ScholarCrossref
76.
Krogsgaard  LR , Lyngesen  M , Bytzer  P .  Systematic review: quality of trials on the symptomatic effects of the low FODMAP diet for irritable bowel syndrome.   Aliment Pharmacol Ther. 2017;45(12):1506-1513. doi:10.1111/apt.14065 PubMedGoogle ScholarCrossref
77.
Ford  AC , Lacy  BE , Harris  LA , Quigley  EMM , Moayyedi  P .  Effect of antidepressants and psychological therapies in irritable bowel syndrome: an updated systematic review and meta-analysis.   Am J Gastroenterol. 2019;114(1):21-39. doi:10.1038/s41395-018-0222-5 PubMedGoogle ScholarCrossref
78.
Hanlon  I , Hewitt  C , Bell  K , Phillips  A , Mikocka-Walus  A .  Systematic review with meta-analysis: online psychological interventions for mental and physical health outcomes in gastrointestinal disorders including irritable bowel syndrome and inflammatory bowel disease.   Aliment Pharmacol Ther. 2018;48(3):244-259. doi:10.1111/apt.14840 PubMedGoogle ScholarCrossref
79.
Everitt  HA , Landau  S , O’Reilly  G ,  et al.  Cognitive behavioural therapy for irritable bowel syndrome: 24-month follow-up of participants in the ACTIB randomised trial.   Lancet Gastroenterol Hepatol. 2019;4(11):863-872. doi:10.1016/S2468-1253(19)30243-2 PubMedGoogle ScholarCrossref
80.
Lackner  JM , Jaccard  J , Radziwon  CD ,  et al.  Durability and decay of treatment benefit of cognitive behavioral therapy for irritable bowel syndrome: 12-month follow-up.   Am J Gastroenterol. 2019;114(2):330-338. doi:10.1038/s41395-018-0396-x PubMedGoogle ScholarCrossref
81.
Black  CJ , Thakur  ER , Houghton  LA , Quigley  EMM , Moayyedi  P , Ford  AC .  Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis.   Gut. 2020;69(8):1441-1451. doi:10.1136/gutjnl-2020-321191 PubMedGoogle ScholarCrossref
82.
Yan  J , Miao  ZW , Lu  J ,  et al.  Acupuncture plus Chinese herbal medicine for irritable bowel syndrome with diarrhea: a systematic review and meta-analysis.   Evid Based Complement Alternat Med. 2019;2019:7680963. doi:10.1155/2019/7680963 PubMedGoogle Scholar
83.
Manheimer  E , Wieland  LS , Cheng  K ,  et al.  Acupuncture for irritable bowel syndrome: systematic review and meta-analysis.   Am J Gastroenterol. 2012;107(6):835-847. doi:10.1038/ajg.2012.66 PubMedGoogle ScholarCrossref
84.
Quartero  AO , Meineche-Schmidt  V , Muris  J , Rubin  G , de Wit  N .  Bulking agents, antispasmodic and antidepressant medication for the treatment of irritable bowel syndrome.   Cochrane Database Syst Rev. 2005;(2):CD003460. doi:10.1002/14651858.CD003460.pub2 PubMedGoogle Scholar
85.
Ford  AC , Talley  NJ , Spiegel  BM ,  et al.  Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis.   BMJ. 2008;337:a2313. doi:10.1136/bmj.a2313 PubMedGoogle ScholarCrossref
86.
Khanna  R , MacDonald  JK , Levesque  BG .  Peppermint oil for the treatment of irritable bowel syndrome: a systematic review and meta-analysis.   J Clin Gastroenterol. 2014;48(6):505-512. doi:10.1097/MCG.0b013e3182a88357 PubMedGoogle ScholarCrossref
87.
Ford  AC , Quigley  EM , Lacy  BE ,  et al.  Effect of antidepressants and psychological therapies, including hypnotherapy, in irritable bowel syndrome: systematic review and meta-analysis.   Am J Gastroenterol. 2014;109(9):1350-1365. doi:10.1038/ajg.2014.148 PubMedGoogle ScholarCrossref
88.
Black  CJ , Burr  NE , Camilleri  M ,  et al.  Efficacy of pharmacological therapies in patients with IBS with diarrhoea or mixed stool pattern: systematic review and network meta-analysis.   Gut. 2020;69(1):74-82. doi:10.1136/gutjnl-2018-318160 PubMedGoogle ScholarCrossref
89.
Andresen  V , Montori  VM , Keller  J , West  CP , Layer  P , Camilleri  M .  Effects of 5-hydroxytryptamine (serotonin) type 3 antagonists on symptom relief and constipation in nonconstipated irritable bowel syndrome: a systematic review and meta-analysis of randomized controlled trials.   Clin Gastroenterol Hepatol. 2008;6(5):545-555. doi:10.1016/j.cgh.2007.12.015 PubMedGoogle ScholarCrossref
90.
Camilleri  M , Acosta  A , Busciglio  I ,  et al.  Effect of colesevelam on faecal bile acids and bowel functions in diarrhoea-predominant irritable bowel syndrome.   Aliment Pharmacol Ther. 2015;41(5):438-448. doi:10.1111/apt.13065 PubMedGoogle ScholarCrossref
91.
Bajor  A , Törnblom  H , Rudling  M , Ung  KA , Simrén  M .  Increased colonic bile acid exposure: a relevant factor for symptoms and treatment in IBS.   Gut. 2015;64(1):84-92. doi:10.1136/gutjnl-2013-305965 PubMedGoogle ScholarCrossref
92.
Menees  SB , Maneerattannaporn  M , Kim  HM , Chey  WD .  The efficacy and safety of rifaximin for the irritable bowel syndrome: a systematic review and meta-analysis.   Am J Gastroenterol. 2012;107(1):28-35. doi:10.1038/ajg.2011.355 PubMedGoogle ScholarCrossref
93.
Chapman  RW , Stanghellini  V , Geraint  M , Halphen  M .  Randomized clinical trial: macrogol/PEG 3350 plus electrolytes for treatment of patients with constipation associated with irritable bowel syndrome.   Am J Gastroenterol. 2013;108(9):1508-1515. doi:10.1038/ajg.2013.197 PubMedGoogle ScholarCrossref
94.
Drossman  DA , Chey  WD , Johanson  JF ,  et al.  Clinical trial: lubiprostone in patients with constipation-associated irritable bowel syndrome—results of two randomized, placebo-controlled studies.   Aliment Pharmacol Ther. 2009;29(3):329-341. doi:10.1111/j.1365-2036.2008.03881.x PubMedGoogle ScholarCrossref
95.
Chey  WD , Drossman  DA , Johanson  JF , Scott  C , Panas  RM , Ueno  R .  Safety and patient outcomes with lubiprostone for up to 52 weeks in patients with irritable bowel syndrome with constipation.   Aliment Pharmacol Ther. 2012;35(5):587-599. doi:10.1111/j.1365-2036.2011.04983.x PubMedGoogle ScholarCrossref
96.
Videlock  EJ , Cheng  V , Cremonini  F .  Effects of linaclotide in patients with irritable bowel syndrome with constipation or chronic constipation: a meta-analysis.   Clin Gastroenterol Hepatol. 2013;11(9):1084-1092.e3. doi:10.1016/j.cgh.2013.04.032 PubMedGoogle ScholarCrossref
97.
Luthra  P , Camilleri  M , Burr  NE , Quigley  EMM , Black  CJ , Ford  AC .  Efficacy of drugs in chronic idiopathic constipation: a systematic review and network meta-analysis.   Lancet Gastroenterol Hepatol. 2019;4(11):831-844. doi:10.1016/S2468-1253(19)30246-8 PubMedGoogle ScholarCrossref
98.
Brenner  DM , Fogel  R , Dorn  SD ,  et al.  Efficacy, safety, and tolerability of plecanatide in patients with irritable bowel syndrome with constipation: results of two phase 3 randomized clinical trials.   Am J Gastroenterol. 2018;113(5):735-745. doi:10.1038/s41395-018-0026-7 PubMedGoogle ScholarCrossref
99.
Barish  CF , Griffin  P .  Safety and tolerability of plecanatide in patients with chronic idiopathic constipation: long-term evidence from an open-label study.   Curr Med Res Opin. 2018;34(4):751-755. doi:10.1080/03007995.2018.1430024 PubMedGoogle ScholarCrossref
100.
Chey  WD , Lembo  AJ , Rosenbaum  DP .  Efficacy of tenapanor in treating patients with irritable bowel syndrome with constipation: a 12-week, placebo-controlled phase 3 trial (T3MPO-1).   Am J Gastroenterol. 2020;115(2):281-293. doi:10.14309/ajg.0000000000000516 PubMedGoogle ScholarCrossref
101.
Evans  BW , Clark  WK , Moore  DJ , Whorwell  PJ .  Tegaserod for the treatment of irritable bowel syndrome and chronic constipation.   Cochrane Database Syst Rev. 2007;(4):CD003960. doi:10.1002/14651858.CD003960.pub3 PubMedGoogle Scholar
102.
Black  CJ , Burr  NE , Ford  AC .  Relative efficacy of tegaserod in a systematic review and network meta-analysis of licensed therapies for irritable bowel syndrome with constipation.   Clin Gastroenterol Hepatol. 2020;18(5):1238-1239.e1. doi:10.1016/j.cgh.2019.07.007 PubMedGoogle ScholarCrossref
103.
Nakajima  A , Seki  M , Taniguchi  S ,  et al.  Safety and efficacy of elobixibat for chronic constipation: results from a randomised, double-blind, placebo-controlled, phase 3 trial and an open-label, single-arm, phase 3 trial.   Lancet Gastroenterol Hepatol. 2018;3(8):537-547. doi:10.1016/S2468-1253(18)30123-7 PubMedGoogle ScholarCrossref
104.
Camilleri  M , Ford  AC .  Pharmacotherapy for irritable bowel syndrome.   J Clin Med. 2017;6(11):101. doi:10.3390/jcm6110101 PubMedGoogle ScholarCrossref
105.
Ford  AC , Harris  LA , Lacy  BE , Quigley  EMM , Moayyedi  P .  Systematic review with meta-analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome.   Aliment Pharmacol Ther. 2018;48(10):1044-1060. doi:10.1111/apt.15001 PubMedGoogle ScholarCrossref
106.
Andriulli  A , Neri  M , Loguercio  C ,  et al.  Clinical trial on the efficacy of a new symbiotic formulation, Flortec, in patients with irritable bowel syndrome: a multicenter, randomized study.   J Clin Gastroenterol. 2008;42(suppl 3 pt 2):S218-S223. doi:10.1097/MCG.0b013e31817fadd6 PubMedGoogle ScholarCrossref
107.
Trifan  A , Burta  O , Tiuca  N , Petrisor  DC , Lenghel  A , Santos  J .  Efficacy and safety of Gelsectan for diarrhoea-predominant irritable bowel syndrome: a randomised, crossover clinical trial.   United European Gastroenterol J. 2019;7(8):1093-1101. doi:10.1177/2050640619862721 PubMedGoogle ScholarCrossref
108.
Pinto-Sanchez  MI , Hall  GB , Ghajar  K ,  et al.  Probiotic Bifidobacterium longum NCC3001 reduces depression scores and alters brain activity: a pilot study in patients with irritable bowel syndrome.   Gastroenterology. 2017;153(2):448-459.e8. doi:10.1053/j.gastro.2017.05.003 PubMedGoogle ScholarCrossref
109.
Pittayanon  R , Lau  JT , Yuan  Y ,  et al.  Gut microbiota in patients with irritable bowel syndrome—a systematic review.   Gastroenterology. 2019;157(1):97-108. doi:10.1053/j.gastro.2019.03.049 PubMedGoogle ScholarCrossref
110.
Ianiro  G , Eusebi  LH , Black  CJ , Gasbarrini  A , Cammarota  G , Ford  AC .  Systematic review with meta-analysis: efficacy of faecal microbiota transplantation for the treatment of irritable bowel syndrome.   Aliment Pharmacol Ther. 2019;50(3):240-248. doi:10.1111/apt.15330 PubMedGoogle ScholarCrossref
111.
El-Salhy  M , Hatlebakk  JG , Gilja  OH , Bråthen Kristoffersen  A , Hausken  T .  Efficacy of faecal microbiota transplantation for patients with irritable bowel syndrome in a randomised, double-blind, placebo-controlled study.   Gut. 2020;69(5):859-867. doi:10.1136/gutjnl-2019-319630 PubMedGoogle ScholarCrossref
112.
Blaser  MJ .  Fecal microbiota transplantation for dysbiosis—predictable risks.   N Engl J Med. 2019;381(21):2064-2066. doi:10.1056/NEJMe1913807 PubMedGoogle ScholarCrossref
113.
Fecal microbiota for transplantation: safety alert—risk of serious adverse events likely due to transmission of pathogenic organisms. US Food and Drug Administration. Posted March 12, 2020. Updated April 7, 2020. Accessed October 23, 2020. https://www.fda.gov/safety/medical-product-safety-information/fecaFl-microbiota-transplantation-safety-alert-risk-serious-adverse-events-likely-due-transmission
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close