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Irritable bowel syndrome (IBS) is a chronic, relapsing and often life-long disorder:

  • characterised by the presence of abdominal pain or discomfort, which may be associated with defaecation and/or accompanied by a change in bowel habit
  • symptoms may include disordered defaecation (constipation or diarrhoea or both) and abdominal distension, usually referred to as bloating
  • symptoms sometimes overlap with other gastrointestinal disorders such as non-ulcer dyspepsia or coeliac disease

The cause is not known; an organic trigger, such as bacterial gastroenteritis, is seen in some patients however there is undoubtedly a psychological component.

NICE (1) note that:

  • a diagnosis of IBS should be considered only if the person has abdominal pain or discomfort that is either relieved by defaecation or associated with altered bowel frequency or stool form. This should be accompanied by at least two of the following four symptoms:
    • altered stool passage (straining, urgency, incomplete evacuation)
    • abdominal bloating (more common in women than men), distension, tension or hardness
    • symptoms made worse by eating
    • passage of mucus
  • other features such as lethargy, nausea, backache and bladder symptoms are common in people with IBS, and may be used to support the diagnosis

  • all people presenting with possible IBS symptoms should be assessed and clinically examined for the following 'red flag' indicators and should be referred to secondary care for further investigation if any are present:
    • signs and symptoms of cancer in line with the NICE guidance on recognition and referral for suspected cancer
    • inflammatory markers for inflammatory bowel disease


  • diagnostic tests In people who meet the IBS diagnostic criteria, the following tests should be undertaken to exclude other diagnoses:
    • full blood count (FBC)
    • erythrocyte sedimentation rate (ESR) or plasma viscosity
    • c-reactive protein (CRP)
    • antibody testing for coeliac disease (endomysial antibodies [EMA] or tissue transglutaminase [TTG])

Management consists various measures including explanation, dietary and lifestyle advice, fibre supplements, antispasmodics and antidepressants.

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