Clinical Review

Irritable bowel syndrome

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e5836 (Published 04 September 2012) Cite this as: BMJ 2012;345:e5836
  1. Alexander C Ford, senior lecturer and honorary consultant gastroenterologist12,
  2. Nicholas J Talley, professor of medicine3
  1. 1Leeds Gastroenterology Institute, St James’s University Hospital, Leeds, UK
  2. 2Leeds Institute of Molecular Medicine, Leeds University, Leeds, UK
  3. 3Faculty of Health, University of Newcastle, New South Wales, Australia
  1. Correspondence to: A Ford, Leeds Gastroenterology Institute, St James’s University Hospital, Leeds LS9 7TF, UK alexf12399{at}yahoo.com

Summary points

  • Irritable bowel syndrome (IBS) affects up to one in five people at some point in their lives

  • The condition is commoner in younger people and women, and is not associated with increased mortality

  • A positive diagnosis of IBS should be reached using symptom based clinical criteria, not after excluding organic disease by exhaustive investigation

  • Exclusion diets (for example, low levels of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) and exercise may be of benefit

  • Soluble fibre, antispasmodics (including peppermint oil), antidepressants, agents acting on the 5-HT receptor, rifaximin, and probiotics are all more effective than placebo for treating IBS

  • Psychological therapies should be reserved for patients failing these treatments

Irritable bowel syndrome (IBS) is one of the commonest gastrointestinal conditions encountered in primary or secondary care. The disorder is more common in younger people, and women. The diagnosis should be reached using symptom based clinical criteria, rather than excluding underlying organic disease by exhaustive investigation. There is no single known unifying cause, but biological markers have been identified. Treatment should be directed towards relief of the predominant symptom (or symptoms) reported, although these may change over time. Since there is no medical therapy established to alter the natural history of IBS in the longer term, the disorder represents a considerable financial burden to the health service, owing to medical consultations and the consumption of other valuable resources. Since the publication of management guidelines from the National Institute for Health and Clinical Excellence in 2008,w1 there have been some significant developments in terms of synthesis of existing evidence, as well as emerging therapies. We therefore summarise recent systematic reviews, meta-analyses, and randomised controlled trials in order to provide a general update as to how to effectively identify and manage this disorder.

Sources and selection criteria

We searched Medline, Embase, the Cochrane Database of Systematic Reviews, …

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