Open Access
Feature Article

Irritable bowel syndrome: an update on diagnosis and management

Open Access
Feature Article

Irritable bowel syndrome: an update on diagnosis and management

YANNA KO, VINCENT HO

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© TEFI/SHUTTERSTOCK
© TEFI/SHUTTERSTOCK
Dr Ko is a Gastroenterology Advanced Trainee at Campbelltown and Camden Hospital and PhD candidate in the School of Medicine, Western Sydney University, Sydney. Dr Ho is a Senior Lecturer in Medicine and a Gastroenterologist at Western Sydney University, Sydney, NSW.

Abstract

Irritable bowel syndrome (IBS) is a common chronic relapsing disorder. A positive diagnosis, in conjunction with a multimodal approach to management, which includes dietary and lifestyle modifications as first-line treatment, followed by pharmacological and psychological therapies, engages and supports patients with IBS.

Key Points

  • The diagnosis of irritable bowel syndrome (IBS) can be made using the ROME IV criteria and subtyped based on predominant symptoms.
  • Clinicians should focus on providing a positive diagnosis of IBS rather than a diagnosis of exclusion. A positive diagnosis enables early introduction of therapy and rationalisation of investigations.
  • Simple noninvasive testing for serum inflammatory markers, coeliac disease serology and faecal calprotectin level should be performed in patients with suspected IBS. Further tests are of low yield, with significant opportunity costs and economic burden.
  • A multimodal treatment approach is preferred in patients with IBS, depending on the severity.
  • Lifestyle and dietary modifications form the first-line treatment for IBS. Subsequent effective therapies include psychological and pharmacological options.
  • Specialist referral should be considered if there is diagnostic uncertainty, lack of response to first-line therapies, or as per patient requests.

Irritable bowel syndrome (IBS) is a chronic, relapsing disorder that affects around one in nine people in Australia.1 Patients suffering from IBS have symptoms of abdominal pain related to defecation or a change in bowel habits. IBS can be a challenging gastrointestinal disorder to manage; pathophysiological mechanisms of gut-brain axis dysfunction, visceral hypersensitivity and exacerbations caused by psychological stress, gastrointestinal infections and the complex relationship between diet and gut microbiota have all been identified as having a role in the pathogenesis of IBS, thus necessitating multimodal management strategies in IBS treatment.2-5 This article summarises the latest recommendations from recently published updated guidelines from gastroenterological societies on diagnostic and management approaches to IBS.6,7 

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