Irritable bowel syndrome (IBS) is one of the most common conditions encountered by both primary care providers and gastroenterologists, with a global population of 11.2% ¹.

A study of 2000 patients with a history of gastrointestinal (GI) symptoms found that 43.1% of those who met the criteria for IBS were undiagnosed, and among those who were diagnosed, 26% were not receiving treatment ². IBS can profoundly affect patients’ mental health. A study found that 38% of patients with IBS attending a tertiary care clinic contemplated suicide because they felt hopeless about ever achieving symptom relief ³.

Diagnostic Pathway

One reason IBS is so hard to diagnose is that it’s a symptom-based disorder, with identification of the condition predicated upon certain key characteristics that are heterogeneous IBS in patient ‘A’ may not present the same way as IBS in patient ‘B,’ although there are certain foundational common characteristics.” IBS involves “abnormalities in the motility and contractility of the GI tract,” he said. It can present with diarrhea (IBS-D), constipation (IBS-C), or a mixture or alternation of diarrhea and constipation (IBS-M). Patients with IBS-D often have an exaggerated gastro-colonic response, while those with IBS-C often have a blunted response.

Several blood tests, procedures, imaging studies, and other tests are available to rule out other organic GI conditions, as outlined in the Table.

Tests to Rule Out Other Organic GI Conditions

Category Test Blood tests Complete blood cell count Liver function tests C-reactive protein Tissue transglutaminase immunoglobulin A antibody (to rule out celiac disease) Procedures Gastroscopy Colonoscopy CT colonography Imaging studies Abdominal ultrasound Abdominal CT scan MRI scan Small bowel capsule endoscopy Additional tests Lactulose or glucose breath testing (to rule out lactose intolerance and small intestinal bacterial overgrowth)

Stress plays a role in exacerbating symptoms in patients with IBS and is and we can’t be able to solve gut issues until we resolve their stress issues. We need to calm the gut-microbiome-brain axis, which is multidimensional and bidirectional.”

Many people — even those without IBS — experience queasiness or diarrhoea prior to a major event they’re nervous about. These events activate the brain, which activates the nervous system, which interacts with the GI tract. Indeed, IBS is now recognised as a disorder of gut-brain interaction. The microbiome in the GI tract influences cognition and emotional function, depression, and anxiety ⁶.