Genetic, environmental, and psychological factors seem to be important in the development of IBS. Studies have shown that IBS has a genetic component even though there is a predominant influence of environmental factors. There is evidence that abnormalities occur in the gut flora of individuals who have IBS, such as reduced diversity, a decrease in bacteria belonging to the phylum Bacteroidetes , and an increase in those belonging to the phylum Firmicutes.
Antibodies against common components namely flagellin of the commensal gut flora are a common occurrence in IBS affected individuals. Chronic low-grade inflammation commonly occurs in IBS affected individuals with abnormalities found including increased enterochromaffin cells , intraepithelial lymphocytes , and mast cells resulting in chronic immune-mediated inflammation of the gut mucosa. No specific laboratory or imaging tests can diagnose irritable bowel syndrome. Diagnosis should be based on symptoms, the exclusion of worrisome features, and the performance of specific investigations to rule out organic diseases that may present similar symptoms.
The recommendations for physicians are to minimize the use of medical investigations.
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They allow the diagnosis to be based only on symptoms, but no criteria based solely on symptoms is sufficiently accurate to diagnose IBS. Physicians may choose to use one of these guidelines or may simply choose to rely on their own anecdotal experience with past patients. The algorithm may include additional tests to guard against misdiagnosis of other diseases as IBS. Such "red flag" symptoms may include weight loss, gastrointestinal bleeding, anemia, or nocturnal symptoms.
The diagnostic algorithm identifies a name that can be applied to the person's condition based on the combination of symptoms of diarrhea, abdominal pain, and constipation. While some researchers believe this categorization system will help physicians understand IBS, others have questioned the value of the system and suggested all people with IBS have the same underlying disease but with different symptoms.
Colon cancer , inflammatory bowel disease, thyroid disorders, and giardiasis can all feature abnormal defecation and abdominal pain. Less common causes of this symptom profile are carcinoid syndrome , microscopic colitis , bacterial overgrowth , and eosinophilic gastroenteritis ; IBS is, however, a common presentation, and testing for these conditions would yield low numbers of positive results, so it is considered difficult to justify the expense.
Ruling out parasitic infections, lactose intolerance, small intestinal bacterial overgrowth, and coeliac disease is recommended before a diagnosis of irritable bowel syndrome is made. An ileocolonoscopy with biopsies is useful to exclude Crohn's disease. People with IBS are at increased risk of being given inappropriate surgeries such as appendectomy , cholecystectomy , and hysterectomy due to being misdiagnosed as other medical conditions. Bile acid malabsorption is also sometimes missed in people with diarrhea-predominant IBS. Chronic use of certain sedative - hypnotic drugs, especially the benzodiazepines , may cause irritable bowel-like symptoms that can lead to a misdiagnosis of irritable bowel syndrome.
Several medical conditions, or comorbidities , appear with greater frequency in people with IBS.
A number of treatments have been found to be effective, including fiber, talk therapy , antispasmodic and antidepressant medication, and peppermint oil. Reduction of fructose and fructan has been shown to reduce IBS symptoms in a dose-dependent manner in people with fructose malabsorption and IBS. FODMAPs are fermentable oligo- , di- , monosaccharides and polyols , which are poorly absorbed in the small intestine and subsequently fermented by the bacteria in the distal small and proximal large intestine.
This is a normal phenomenon, common to everyone. The resultant production of gas potentially results in bloating and flatulence. They are globally trimmed, rather than individually, which is more successful than for example restricting only fructose and fructans, which are also FODMAPs, as is recommended for those with fructose malabsorption.
A low-FODMAP diet might help to improve short-term digestive symptoms in adults with irritable bowel syndrome,     but its long-term follow-up can have negative effects because it causes a detrimental impact on the gut microbiota and metabolome. Some evidence suggests soluble fiber supplementation e.
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For people with IBS-C, it seems to allow for a softer, moister, more easily passable stool. However, insoluble fiber e.
Treatment for Irritable Bowel Syndrome | NIDDK
Fiber might be beneficial in those who have a predominance of constipation. In people who have IBS-C, soluble fiber can reduce overall symptoms, but will not reduce pain. The research supporting dietary fiber contains conflicting small studies complicated by the heterogeneity of types of fiber and doses used. One meta-analysis found only soluble fiber improved global symptoms of irritable bowel, but neither type of fiber reduced pain.
Medications that may be useful include antispasmodics such as dicyclomine and antidepressants. For people who do not adequately respond to dietary fiber, osmotic laxatives such as polyethylene glycol , sorbitol , and lactulose can help avoid " cathartic colon " which has been associated with stimulant laxatives.
The use of antispasmodic drugs e. A meta-analysis by the Cochrane Collaboration concludes if seven people are treated with antispasmodics, one of them will benefit. Musculotropics, such as mebeverine , act directly at the smooth muscle of the gastrointestinal tract, relieving spasm without affecting normal gut motility. Proton pump inhibitors PPIs used to suppress stomach acid production may cause bacterial overgrowth leading to IBS symptoms.
Discontinuation of PPIs in selected individuals has been recommended as it may lead to an improvement or resolution of IBS symptoms. There is good evidence that low doses of tricyclic antidepressants can be effective for IBS. However, the evidence is less robust as to the effectiveness of other antidepressant classes such as Selective serotonin reuptake inhibitor antidepressants SSRIs. Antidepressants are not effective for IBS in people with depression, possible because lower doses of antidepressants than the doses used to treat depression are required for relief of IBS.
SSRIs , because of their serotonergic effect, have been studied to see if they help IBS, especially people who are constipation predominant but as of the evidence is that SSRIs do not help. Magnesium aluminum silicates and alverine citrate drugs can be effective for IBS. Evidence is conflicting about the benefit of antidepressants in IBS. Some meta-analyses have found a benefit, while others have not.
Irritable bowel syndrome (IBS)
Rifaximin may be useful as a treatment for IBS symptoms, including abdominal bloating and flatulence, although relief of abdominal distension is delayed. In individuals with IBS and low levels of vitamin D supplementation is recommended. Some evidence suggests that vitamin D supplementation may improve symptoms of IBS, but further research is needed before it can be recommended as a specific treatment for IBS. Domperidone , a dopamine receptor blocker and a parasympathomimetic, has been shown to reduce bloating and abdominal pain as a result of an accelerated colon transit time and reduced fecal load, that is, a relief from 'hidden constipation'; defecation was similarly improved.
Reduction in IBS symptoms occurs following antibiotic therapy for small intestinal bacterial overgrowth. There is low quality evidence from studies with poor methodological quality that psychological therapies can be effective in the treatment of IBS; however there are no significant adverse effects from psychological therapies for IBS. Reducing stress may reduce the frequency and severity of IBS symptoms.
Techniques that may be helpful include:. A meta-analysis found no benefits of acupuncture relative to placebo for IBS symptom severity or IBS-related quality of life. Probiotics can be beneficial in the treatment of IBS; taking 10 billion to billion beneficial bacteria per day is recommended for beneficial results. However, further research is needed on individual strains of beneficial bacteria for more refined recommendations. A number of probiotics have been found to be effective, including Lactobacillus plantarum ,  and Bifidobacteria infantis ;  but one review found only Bifidobacteria infantis showed efficacy.
Certain probiotics have different effects on certain symptoms of IBS. For example, Bifidobacterium breve , B. Most clinical studies show probiotics do not improve straining, sense of incomplete evacuation, stool consistency, fecal urgency, or stool frequency, although a few clinical studies did find some benefit of probiotic therapy. The evidence is conflicting for whether probiotics improve overall quality of life scores.
Probiotics may exert their beneficial effects on IBS symptoms via preserving the gut microbiota, normalisation of cytokine blood levels, improving the intestinal transit time, decreasing small intestine permeability, and by treating small intestinal bacterial overgrowth of fermenting bacteria. Peppermint oil appears useful. Occasionally, nausea and perianal burning occur as side effects. Only limited evidence exists for the effectiveness of other herbal remedies for IBS. As with all herbs, it is wise to be aware of possible drug interactions and adverse effects. The prevalence of IBS varies by country and by age range examined.
The bar graph at right shows the percentage of the population reporting symptoms of IBS in studies from various geographic regions see table below for references. The following table contains a list of studies performed in different countries that measured the prevalence of IBS and IBS-like symptoms:.