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Diagnosis and management of IBS

Abstract

IBS is a common gastrointestinal condition characterized by chronic or recurrent abdominal pain associated with altered bowel habits. IBS is considered a functional bowel disorder (that is, not defined by structural or biochemical abnormalities) and is diagnosed using symptom-based criteria. Limited and judicious use of diagnostic testing is recommended, particularly in patients with typical symptoms of IBS without alarm signs and symptoms. Management of IBS is based on a multifactorial approach and includes establishment of an effective patient–provider relationship, education, reassurance, dietary alterations, pharmacotherapy, behavioral and psychological treatment. Patient-centered care is recommended, in which management is focused on the patient's most bothersome and impactful symptoms, their preferences and previous experiences with treatment, and addressing factors associated with the onset and exacerbation of symptoms. Pharmacotherapy is typically targeted against the predominant symptom. This Review discusses the current evidence-based recommendations for the diagnosis and management of IBS. An improved understanding of the recommended diagnostic and therapeutic approaches for IBS will lead to greater patient satisfaction, as well as reduced health-care costs.

Key Points

  • IBS can be confidently diagnosed with symptom-based criteria in the absence of alarm signs

  • Management of IBS involves an integrative approach, including establishment of an effective patient–provider relationship, education, reassurance, dietary alterations, pharmacotherapy aimed at the most bothersome symptoms, behavioral and psychological treatment

  • Fiber, laxatives, a chloride channel activator and, rarely, 5-HT4 agonists are used to treat constipation-predominant symptoms

  • Antidiarrheal agents, antibiotics, tricyclic antidepressants and, in severe cases, a 5-HT3 antagonist are used to treat diarrhea-predominant symptoms

  • Dietary measures, probiotics and antibiotics may be efficacious for reducing bloating and gas; antidepressants and anticholinergics can help relieve abdominal pain

  • Effective psychological and behavioral treatment interventions for IBS include cognitive behavioral therapy, hypnosis, psychotherapy and stress management

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Figure 1: Graduated treatment approach for IBS.

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Acknowledgements

Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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Both authors contributed equally to the research, discussion, writing and reviewing of the article.

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Correspondence to Lin Chang.

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S. Khan declares no competing interests. L. Chang has served as a consultant for Albireo, Forest, GlaxoSmithKline, Ironwood, McNeil, Movetis, Ocera, Prometheus Laboratories, Rose Pharma, Salix and Takeda. She has received research funding from Takeda, Rose and Prometheus.

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Khan, S., Chang, L. Diagnosis and management of IBS. Nat Rev Gastroenterol Hepatol 7, 565–581 (2010). https://doi.org/10.1038/nrgastro.2010.137

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