In gastroenterology, irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain, discomfort or bloating relieved by defecation and alteration of bowel habits. Diarrhea or constipation may predominate, or they may alternate (classified as IBS-D, IBS-C or IBS-A, respectively). IBS may begin after an infection (post-infectious, IBS-PI) or a stressful life event. Other functional or pain disorders and certain psychological conditions are more common in those with IBS. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // K00-K93 - Diseases of the digestive system (K00-K14) Diseases of oral cavity, salivary glands and jaws (K00) Disorders of tooth development and eruption (K01) Embedded and impacted teeth (K02) Dental caries (K03) Other diseases of hard tissues of teeth (K04) Diseases of pulp and periapical tissues (K040) Pulpitis (K05... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... In medicine, inflammatory bowel disease (IBD) is a group of inflammatory conditions of the large intestine and, in some cases, the small intestine. ... Gastroenterology (MeSH heading[2] ) is the branch of medicine where the digestive system and its disorders are studied. ... In medicine, the term functional bowel disorder refers to a group of disorders which are characterised by chronic abdominal complaints without a structural or biochemical cause that could explain symptoms. ... Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. ... For the death metal band, see Defecation (band). ... In medicine, diarrhea, also spelled diarrhoea (see spelling differences), refers to frequent loose or liquid bowel movements. ... Constipation, costiveness, or irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to egest. ... An infection is the detrimental colonization of a host organism by a foreign species. ... In medical terms, stress is the disruption of homeostasis through physical or psychological stimuli. ... Pain disorder or body dysmorphic disorder is when a patient experiences chronic and constant pain in one or more areas, and is thought to be caused by psychological stress. ... {redirect|Psychological science|the journal|Psychological Science (journal)}} Not to be confused with Phycology. ...

Treatment for IBS can include dietary adjustments, medication and psychological interventions. Patient education and a good doctor-patient relationship are also important.^[1] This article does not cite any references or sources. ... Psychotherapy is an interpersonal, relational intervention used by trained psychotherapists to aid clients in problems of living. ... The patient-doctor relationship is considered to be essential in modern medicine and forms one of the foundations of contemporary medical ethics. ...

Several conditions may mimic IBS including celiac disease, several inflammatory bowel diseases, functional chronic constipation and chronic functional abdominal pain. In IBS, routine clinical tests yield no abnormalities, though the bowels may be more sensitive to certain stimuli, such as balloon insufflation testing. The exact cause of IBS is unknown. The most common theory is that IBS is a disorder of the interaction between the brain and the gut, although there may also be abnormalities in the gut flora or the immune system. Coeliac disease (also termed non-tropical sprue, celiac disease and gluten intolerance) is an autoimmune disease characterised by chronic inflammation of the proximal portion of the small intestine caused by exposure to certain dietary gluten proteins. ... In medicine, inflammatory bowel disease (IBD) is a group of inflammatory conditions of the large intestine and, in some cases, the small intestine. ... Functional constipation is a form of constipation with a psychological or psychosomatic background. ... Chronic functional abdominal pain (CFAP) is the ongoing presence of abdominal pain for which there is no physical explanation. ... Idiopathic means arising spontaneously or from an obscure or unknown cause. ... For other uses, see Brain (disambiguation). ... For the Physics term GUT, please refer to Grand unification theory The gastrointestinal or digestive tract, also referred to as the GI tract or the alimentary canal or the gut, is the system of organs within multicellular animals which takes in food, digests it to extract energy and nutrients, and... Escherichia coli, one of the many species of bacteria present in the human gut. ... A scanning electron microscope image of a single neutrophil (yellow), engulfing anthrax bacteria (orange). ...

Symptoms

The primary symptoms of IBS are abdominal pain or discomfort in association with frequent diarrhea, constipation, or a change in bowel habits.^[2] There may also be urgency for bowel movements, a feeling of incomplete evacuation (tenesmus), bloating or abdominal distention.^[3] People with IBS more commonly than others have gastroesophageal reflux, symptoms relating to the genitourinary system, psychological symptoms, fibromyalgia, headache and backache.^[3] A symptom is a manifestation of a disease, indicating the nature of the disease, which is noticed by the patient. ... Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. ... In medicine, diarrhea, also spelled diarrhoea (see spelling differences), refers to frequent loose or liquid bowel movements. ... Constipation, costiveness, or irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to egest. ... Tenesmus is the constant feeling of the need to empty the bowel, accompanied by pain, cramping, and involuntary straining efforts. ... Gastroesophageal Reflux Disease (GERD, or GORD when -oesophageal, the BE form, is substituted) is injury to the esophagus that develops from chronic exposure of the esophagus to acid coming up from the stomach (reflux). ... In anatomy, the genitourinary system is the organ system of all the reproductive organs and the urinary system. ... Fibromyalgia (FM) is stated to be a disorder classified by the presence of chronic widespread pain and tactile allodynia. ... A headache (cephalgia in medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ... Back pain is one of humanitys most frequent complaints and does not usually reflect any underlying disease. ...

IBS can be classified as either diarrhea-predominant (IBS-D), constipation-predominant (IBS-C) or IBS with alternating stool pattern (IBS-A or pain-predominant^[4]). In some individuals, IBS may have an acute onset and develop after an infectious illness characterised by two or more of the following: fever, vomiting, diarrhea, or positive stool culture. This post-infective syndrome has consequently been termed "post-infectious IBS" (IBS-PI). In medicine, diarrhea, also spelled diarrhoea (see spelling differences), refers to frequent loose or liquid bowel movements. ... Constipation, costiveness, or irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to egest. ... Infection is also the title of an episode of the television series Babylon 5; see Infection (Babylon 5). ... An analogue medical thermometer showing the temperature of 38. ... Heaving redirects here. ... In medicine, diarrhea, also spelled diarrhoea (see spelling differences), refers to frequent loose or liquid bowel movements. ... A stool test is one where fecal matter is collected for analysis to diagnose the presence or absence of a medical condition. ...

Diagnosis

There is no specific laboratory or imaging test which can be performed to diagnose irritable bowel syndrome.^[5] Diagnosis of IBS involves excluding conditions which produce IBS-like symptoms, and then following a procedure to categorize the patient's symptoms.

Because there are many causes of diarrhea and IBS-like symptoms, the American Gastroenterological Association has published a set of guidelines for tests to be performed to diagnose other conditions which may have symptoms similar to IBS. These include gastrointestinal infections, lactose intolerance and Coeliac disease. Research has suggested that these guidelines are not always followed.^[5] Once other causes have been excluded, the diagnosis of IBS is performed using a diagnostic algorithm. Well-known algorithms include the Manning Criteria, the Rome I Criteria, the Rome II Process, the Kruis Criteria, and studies have compared their reliability.^[6] The more recent Rome III Process was published in 2006. Physicians may choose to use one of these criteria, or may use other guidelines based on their own experience and the patient's history. The algorithm may include additional tests to guard against mis-diagnosis of other diseases as IBS. Such "red flag" symptoms may include weight loss, GI bleeding, anemia, or nocturnal symptoms. However, researchers have noted that red flag conditions may not always contribute to accuracy in diagnosis — for instance, as many as 31% of IBS patients have blood in their stool.^[6] Diarrhea (in American English) or diarrhoea (in British English) is a condition in which the sufferer has frequent watery, loose bowel movements. ... Founded in 1897, the American Gastroenterological Association is the oldest medical-specialty society in the United States. ... The American Gastroenterological Association has published a set of guidelines for tests which physicians should perform prior to diagnosing Irritable Bowel Syndrome. ... Coeliac disease (pronounced ), also spelt celiac disease, is an autoimmune disorder of the small bowel that occurs in genetically predisposed people of all ages from middle infancy. ... Flowcharts are often used to graphically represent algorithms. ... Flowcharts are often used to represent algorithms. ... The Manning Criteria is a diagnostic algorithm used in the diagnosis of Irritable Bowel Syndrome. ... The Rome Process is an international effort to define and categorize the functional gastrointestinal disorders (of unknown cause) such as Irritable bowel syndrome and Functional dyspepsia. ... The Rome Process is an international effort to define and categorize the functional gastrointestinal disorders (of unknown cause) such as Irritable bowel syndrome and Functional dyspepsia. ... The Rome Process is an international effort to define and categorize the functional gastrointestinal disorders (of unknown cause) such as Irritable bowel syndrome and Functional dyspepsia. ... Flowcharts are often used to graphically represent algorithms. ...

The diagnostic algorithm identifies a name which can be applied to the patient's condition based on the combination of the patient's symptoms of diarrhea, abdominal pain, and constipation. For example, the statement "50% of returning travelers had developed functional diarrhea while 25% had developed IBS" would mean that half the travelers had diarrhea while a quarter had diarrhea with abdominal pain. While some researchers believe this categorization system will help physicians understand IBS, others have questioned the value of the system and suggested that all IBS patients have the same underlying disease but with different symptoms.^[7] Flowcharts are often used to graphically represent algorithms. ... In medicine, diarrhea, also spelled diarrhoea (see spelling differences), refers to frequent loose or liquid bowel movements. ... In medicine, diarrhea, also spelled diarrhoea (see spelling differences), refers to frequent loose or liquid bowel movements. ... In medicine, diarrhea, also spelled diarrhoea (see spelling differences), refers to frequent loose or liquid bowel movements. ... In medicine, diarrhea, also spelled diarrhoea (see spelling differences), refers to frequent loose or liquid bowel movements. ...

Misdiagnosis

Published research has demonstrated that some poor patient outcomes are due to treatable causes of diarrhea being mis-diagnosed as IBS. Common examples include infectious diseases, celiac disease,^[8] parasites,^[9] food allergies^[10] (though considered controversial), and lactose intolerance.^[11] See List of causes of diarrhea for other conditions which can cause diarrhea. In medicine, infectious disease or communicable disease is disease caused by a biological agent (e. ... Coeliac disease (also termed non-tropical sprue, celiac disease and gluten intolerance) is an autoimmune disease characterised by chronic inflammation of the proximal portion of the small intestine caused by exposure to certain dietary gluten proteins. ... Diarrhea (in American English) or diarrhoea (in British English) is a condition in which the sufferer has frequent watery, loose bowel movements. ...

Coeliac disease in particular is often misdiagnosed as IBS: Coeliac disease (pronounced ), also spelt celiac disease, is an autoimmune disorder of the small bowel that occurs in genetically predisposed people of all ages from middle infancy. ...

Recognizing celiac disease can be difficult because some of its symptoms are similar to those of other diseases. In fact, sometimes celiac disease is confused with irritable bowel syndrome, iron-deficiency anemia caused by menstrual blood loss, Crohn’s disease, diverticulitis, intestinal infections, and chronic fatigue syndrome. As a result, celiac disease is commonly underdiagnosed or misdiagnosed.^[12]

Medical conditions that accompany IBS

Researchers have identified several medical conditions, or comorbidities, which appear with greater frequency in patients diagnosed with IBS. In medicine and in psychiatry, comorbidity refers to: The presence of one or more disorders (or diseases) in addition to a primary disease or disorder. ...

Headache, Fibromyalgia, and Depression: A study of 97,593 individuals with IBS identified comorbidities as headache, fibromyalgia, and depression.^[13] Fibromyalgia has also been identified in other studies as a comorbidity of IBS.^[14][15]

Inflammatory bowel disease: Some researchers have suggested that IBS is a type of low-grade inflammatory bowel disease.^[16] Researchers have suggested that IBS and IBD are interrelated diseases,^[17] noting that patients with IBD experience IBS-like symptoms when their IBD is in remission.^[18][19] A 3-year study found that patients diagnosed with IBS were 16.3 times more likely to develop IBD during the study period.^[20] Serum markers associated with inflammation have also been found in patients with IBS (see Causes).

Abdominal surgery: A 2005 study published in Digestive Disease Science reported that IBS patients are 87% more likely to undergo abdominal and pelvic surgery, and three times more likely to undergo gallbladder surgery.^[21] A study published in Gastroenterology came to similar conclusions, and also noted IBS patients were twice as likely to undergo hysterectomy.^[22]

Endometriosis: One study has reported a statistically significant link between migraine headaches, IBS, and endometriosis.^[23]

Other chronic disorders. Interstitial cystitis may be associated with other chronic pain syndromes, such as irritable bowel syndrome and fibromyalgia. The connection between these syndromes is unknown. http://www.mayoclinic.com/health/interstitial-cystitis/DS00497/DSECTION=4 Fibromyalgia (FM) is stated to be a disorder classified by the presence of chronic widespread pain and tactile allodynia. ... Fibromyalgia (FM) is stated to be a disorder classified by the presence of chronic widespread pain and tactile allodynia. ... Fibromyalgia (FM) is stated to be a disorder classified by the presence of chronic widespread pain and tactile allodynia. ... In medicine, inflammatory bowel disease (IBD) is a group of inflammatory conditions of the large intestine and, in some cases, the small intestine. ...

Etiology

Initially, IBS was considered a psychosomatic illness and the involvement of biological and pathogenic factors was not verified until the 1990s, a process common in the history of emerging infectious diseases. The risk of developing IBS increases six-fold after acute gastrointestinal infection. Post-infection, further risk factors are young age, prolonged fever, anxiety and depression.^[24] The discovery of new pathogens is an important activity in the field of medical science. ...

Psychosomatic illness

One of the first references to the concept of an "irritable bowel" appeared in the Rocky Mountain Medical Journal in 1950.^[26] The term was used to categorize patients who developed symptoms of diarrhea, abdominal pain, constipation, but where no well-recognized infective cause could be found. Early theories suggested that the Irritable Bowel was caused by a psychosomatic, or mental disorder. One paper from the 1980s investigated "learned illness behavior" in patients with IBS and peptic ulcers.^[27] Another study suggested that both IBS and stomach ulcer patients would benefit from 15 months of psychotherapy.^[28] Later, it would be found that most stomach ulcers were caused by a bacterial infection with Helicobacter pylori.^[29] Peptic ulcer is a non-malignant ulcer of the stomach (called gastric ulcer) or duodenum (called duodenal ulcer). ... Psychotherapy is an interpersonal, relational intervention used by trained psychotherapists to aid clients in problems of living. ... Binomial name ((Marshall 1985) Goodwin 1989) ICD-9 code: 041. ...

Additional publications suggesting the role of brain-gut "axis" appeared in the 1990s, such as a study entitled Brain-gut response to stress and cholinergic stimulation in IBS published in the Journal of Clinical Gastroenterology in 1993.^[30] A 1997 study published in Gut magazine suggested that IBS was associated with a "derailing of the brain-gut axis."^[31]

Immune reaction

From the late 1990s, research publications began identifying specific biochemical changes present in tissue biopsies and serum samples from IBS patients that suggested symptoms had an organic rather than psychosomatic cause. These studies identified cytokines and secretory products in tissues taken from IBS patients. The cytokines identified in IBS patients produce inflammation and are associated with the body's immune response. A psychosomatic illness is one with physical manifestations and supposed psychological cause, often diagnosed when any known or identifiable physical cause was excluded by medical examination. ... Cytokines are a category of less-widely-known signalling proteins and glycoproteins that, like hormones and neurotransmitters, are used extensively in cellular communication. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... Immunity is a medical term that describes a state of having sufficient biological defenses to avoid infection, disease, or other unwanted biological invasion. ...

• A study showed that intestinal biopsies from patients with constipation predominant IBS secreted higher levels of serotonin in-vitro.^[32] Serotonin plays a role in regulating gastrointestinal motility and water content, and can be altered by some diseases and infections.^[33][34][35]

• A study of rectal biopsy tissue from IBS patients showed increased levels of cellular structures involved in the production of the cytokine Interleukin 1 Beta.^[36]

• A study of blood samples from IBS patients identified elevated levels of cytokines Tumor necrosis factor-alpha, Interleukin 1, and Interleukin 6 in patients with IBS.^[37]

• A study of intestinal biopsies from IBS patients showed increased levels of protease enzymes used by the body to digest proteins, and by infectious agents to combat the host's immune system.^[38]

• A study of blood samples from IBS patients found elevated levels of antibodies to the protozoan Blastocystis.^[39]

Specific forms of immune response that have been implicated in IBS symptoms include Coeliac disease and other Food allergy conditions.^[40] Coeliac disease (also spelled "celiac") is an immunoglobulin type A-(IgA) mediated allergic response to the Gliadin protein in gluten grains,which exhibits wide variety of symptoms and can present as IBS. "Some patients with diarrhea-predominant irritable bowel syndrome (IBS-D) may have undiagnosed celiac sprue (CS). Because the symptoms of CS respond to a gluten-free diet, testing for CS in IBS may prevent years of morbidity and attendant expense."^[41] "Coeliac disease is a common finding among patients labelled as irritable bowel syndrome. In this sub-group, a gluten free diet may lead to a significant improvement in symptoms. Routine testing for coeliac disease may be indicated in all patients being evaluated for irritable bowel syndrome."^[42] Food allergies, particularly those mediated by IgE and IgG-type antibodies have been implicated in IBS.^[43][44][45] A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ... For the professional wrestling stable, see Ravens Nest#Serotonin. ... For the professional wrestling stable, see Ravens Nest#Serotonin. ... Interleukin-1 (IL-1) is secreted by the macrophages, monocytes and dendritic cells. ... In medicine, tumor necrosis factor alpha (TNFα, cachexin or cachectin) is an important cytokine involved in systemic inflammation and the acute phase response. ... Interleukin-1 (IL-1) is secreted by the macrophages, monocytes and dendritic cells. ... Interleukin-6 (IL-6) is a pro-inflammatory cytokine secreted by T cells and macrophages to stimulate immune response to trauma, especially burns or other tissue damage leading to inflammation. ... Proteases (proteinases, peptidases, or proteolytic enzymes) are enzymes that break peptide bonds between amino acids of proteins. ... A scanning electron microscope image of a single neutrophil (yellow), engulfing anthrax bacteria (orange). ... Wikipedia does not yet have an article with this exact name. ... Protozoa (in Greek protos = first and zoon = animal) are single-celled creatures with nuclei that show some characteristics usually associated with animals, most notably mobility and heterotrophy. ... For the disease, see Blastocystosis. ... Coeliac disease (pronounced ), also spelt celiac disease, is an autoimmune disorder of the small bowel that occurs in genetically predisposed people of all ages from middle infancy. ... A food allergy is an immunologic response to a food protein. ... Coeliac disease (pronounced ), also spelt celiac disease, is an autoimmune disorder of the small bowel that occurs in genetically predisposed people of all ages from middle infancy. ... Gliadin is a glycoprotein, present in wheat and some other cereals, best known for its role, along with glutenin, in the formation of gluten. ...

Active infections

There is research to support IBS being caused by an as-yet undiscovered active infection. Most recently, a study has found that the antibiotic Rifaximin provides sustained relief for IBS patients.^[47] While some researchers see this as evidence that IBS is related to an undiscovered agent, others believe IBS patients suffer from overgrowth of intestinal flora and the antibiotics are effective in reducing the overgrowth (known as small intestinal bacterial overgrowth).^[48] Other researchers have focused on an unrecognized protozoal infection as a cause of IBS^[49] as certain protozoal infections occur more frequently in IBS patients.^[50][51] Two of the protozoa investigated have a high prevalence in industrialized countries and infect the bowel, but little is known about them as they are recently emerged pathogens. Sworn enemy of the American Gastroenterological Association (AGA), The American College of Gastroenterology (ACG), founded in 1932, serves to advance the scientific study and medical practice of diseases of the gastrointestinal tract. ... Rifaximin Xifaxan Rifaximin is a nonabsorbable antibiotic, meaning that the drug will not pass the gastrointestinal wall into the circulation as is common for other types of orally administered antibiotics. ... Escherichia coli, one of the many species of bacteria present in the human gut. ... Small bowel bacterial overgrowth syndrome (SBBOS), or small intestinal bacterial overgrowth (SIBO), also termed bacterial overgrowth; is a disorder of excessive bacterial growth in the small intestine. ... Leishmania donovani, (a species of protozoan) in a bone marrow cell (in Greek proto = first and zoa = animals) are one-celled eukaryotes (that is, unicellular microbes whose cells have membrane-bound nuclei) that commonly show characteristics usually associated with animals, mobility and heterotrophy. ...

Blastocystis is a single-celled organism which has been reported to produce symptoms of abdominal pain, constipation and diarrhea in patients, along with headaches and depression,^[52] though these reports are contested by some physicians.^[53] Studies from research hospitals in various countries have identified high Blastocystis infection rates in IBS patients, with 38% being reported from London School of Hygiene & Tropical Medicine,^[54] 47% reported from the Department of Gastroenterology at Aga Khan University in Pakistan^[50] and 18.1% reported from the Institute of Diseases and Public Health at University of Ancona in Italy.^[51] Reports from all three groups indicate a Blastocystis prevalence of approximately 7% in non-IBS patients. Researchers have noted that clinical diagnostics fail to identify infection,^[55] and Blastocystis may not respond to treatment with common antiprotozoals.^{[56][57][58][59]} For the disease, see Blastocystosis. ... For the disease, see Blastocystosis. ... Main entrance The London School of Hygiene & Tropical Medicine (LSHTM or the London School) is a leading postgraduate institution in Europe for public health and tropical medicine, and is associated with the World Health Organization (WHO). ... The Aga Khan University (AKU) is an elite coeducational university in Pakistan. ... Wikipedia does not have an article with this exact name. ... For the disease, see Blastocystosis. ...

Further information: Blastocystosis

Prevalence of protozoal infections in industrialized countries (United States and Canada) in 21st century.^[60][61]

Dientamoeba fragilis is a single-celled organism which produces abdominal pain and diarrhea. Studies have reported a high incidence of infection in developed countries, and symptoms of patients resolve following antibiotic treatment.^[60][62] One study reported on a large group of patients with IBS-like symptoms who were found to be infected with Dientamoeba fragilis, and experienced resolution of symptoms following treatment.^[63] Researchers have noted that methods used clinically may fail to detect some Dientamoeba fragilis infections.^[62] Blastocystosis refers to a medical condition caused by infection with Blastocystis. ... Image File history File links Size of this preview: 800 × 540 pixelsFull resolution (1238 × 835 pixel, file size: 234 KB, MIME type: image/jpeg) Prevalence of protozoal infections in US and Canadian studies, 2000 and 2005. ... Image File history File links Size of this preview: 800 × 540 pixelsFull resolution (1238 × 835 pixel, file size: 234 KB, MIME type: image/jpeg) Prevalence of protozoal infections in US and Canadian studies, 2000 and 2005. ... Dientamoeba fragilis is a type of amoeba that has been known to cause symptoms in some of the people who have this parasite. ... Dientamoeba fragilis is a type of amoeba that has been known to cause symptoms in some of the people who have this parasite. ...

Further information: Dientamoeba fragilis

Dientamoeba fragilis is a type of amoeba that has been known to cause symptoms in some of the people who have this parasite. ...

Treatment

Treatment for IBS, as for any physiological condition, works best when it successfully addresses the cause of the condition. The various conditions that can cause IBS, outlined in the Diagnosis and Etiology sections above, require specific treatments. High rates of success in resolving IBS symptoms have been reported when treatment is specifically tailored to the underlying causes revealed through proper testing for the range of known causes of IBS symptoms.^[40]

A questionnaire in 2006 designed to identify patients’ perceptions about IBS, their preferences on the type of information they need, as well as educational media and expectations from health care providers, revealed misperceptions about IBS developing into other conditions, including colitis, malnutrition, and cancer.^[64] Colitis is a digestive disease characterized by inflammation of the colon. ... Percentage of population affected by malnutrition by country, according to United Nations statistics. ... Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ...

The survey found IBS patients were most interested in learning about foods to avoid (60%), causes of IBS (55%), medications (58%), coping strategies (56%), and psychological factors related to IBS (55%). The respondents indicated that they wanted their physicians to be available via phone or e-mail following a visit (80%), have the ability to listen (80%), and provide hope (73%) and support (63%).

Diet

There are a number of dietary changes a person with IBS can make to prevent the overreaction of the gastrocolic reflex and lessen pain, discomfort, and bowel dysfunction. Having soluble fiber foods and supplements, substituting milk products with soy or rice products, being careful with fresh fruits and vegetables that are high in insoluble fiber, and eating frequent meals of small amounts of food, can all help to lessen the symptoms of IBS. Foods and beverages to be avoided or minimized include red meat, oily or fatty and fried products, milk products (even when there is no lactose intolerance), solid chocolate, coffee (regular and decaffeinated), alcohol, carbonated beverages, especially those containing sorbitol or other artificial sweeteners. Care, however, should be taken to avoid adding foods to the diet to which the patient is allergic or intolerant.^[65] Dietary fibers are the indigestible portion of plant foods that move food through the digestive system, absorbing water and making defecation easier. ... Dietary fibers are the indigestible portion of plant foods that move food through the digestive system, absorbing water and making defecation easier. ... A glass of cows milk. ... For other uses, see Chocolate (disambiguation). ... For other uses, see Coffee (disambiguation). ... Booze redirects here. ... Sorbitol, also known as glucitol, is a sugar alcohol the body metabolises slowly. ...

Definitive determination of dietary issues can be accomplished by testing for the physiological effects of specific foods. The ELISA food allergy panel can identify specific foods to which a patient has a reaction. Other testing can determine if there are nutritional deficiencies secondary to diet that may also play a role. Removal of foods causing IgG immune response as measured using the ELISA food panel has been shown to substantially decrease symptoms of IBS in several studies.^[66] Elisa (born Elisa Toffoli on 19 December 1977) is an Italian singer and solo artist, writing and performing within several genres, notably rock, blues, soul and ambient. ...

There is no evidence that digestion of food or absorption of nutrients is problematic for those with IBS at rates different from those without IBS. However, the very act of eating or drinking can provoke an overreaction of the gastrocolic response in some patients with IBS due to their heightened visceral sensitivity, and this can lead to abdominal pain, diarrhea, and/or constipation.^[67] The gastrocolic reflex or gastrocolic response is one of a number of physiological reflexes controlling the motility, or peristalsis, of the gastrointestinal tract. ...

Several of the most common dietary triggers are well-established by clinical studies at this point; research has shown that IBS patients are hypersensitive to fats and fructose.^[68][69]

It also appears that some foods are more difficult for the gut as evidenced by elevated food-specific IgG4 antibodies being present,^[70][71] while others increase colonic contractions, which may be painful, due to increased visceral sensitivity in IBS sufferers.^[72]

Fiber

In patients who do not have diarrhea predominant irritable bowel, soluble fiber at doses of 20 grams per day can reduce overall symptoms but will not reduce pain. The research supporting dietary fiber contains conflicting, small studies that are complicated by the heterogeneity of types of fiber and doses used.^[73] The one meta-analysis that controlled for solubility found that only soluble fiber improved global symptoms of irritable bowel and neither type of fiber reduced pain^[73] Positive studies have used 20-30 grams per day of psyllium seed.^[74][75] One study specifically examined the effect of dose and found that 20 grams of ispaghula husk was better than 10 grams and equivalent to 30 grams per day^[76]An uncontrolled study noted increased symptoms with insoluble fibers.^[77] It is unclear if these symptoms are truly increased compared to a control group. If the symptoms are increased, it is unclear if these patients were diarrhea predominant (which can be exacerbated by insoluble fiber^[78][79]), or if the increase is temporary before benefit occurs. There is a mistaken presumption that fiber therapy only works for those with constipation. In actuality soluble fiber can act as a counterbalance to both constipation, by retaining water in the bowel, and for diarrhea, by absorbing excess water. Dietary fibers are the indigestible portion of plant foods that move food through the digestive system, absorbing water and making defecation easier. ... A meta-analysis is a statistical practice of combining the results of a number of studies. ... Psyllium or Ispaghula is the common name used for several members of the plant genus Plantago whose seeds are used commercially for the production of mucilage. ...

Medication

Initial treatments

Medications may consist of stool softeners and laxatives in constipation-predominant IBS, and antidiarrheals (e.g., opioid or opioid analogs such as loperamide, diphenoxylate or codeine in diarrhea-predominant IBS for mild symptoms.^[80][81][82] Laxatives (or purgatives) are foods, compounds, or drugs taken to induce bowel movements or to loosen the stool, most often taken to treat constipation. ... An opioid is a chemical substance that has a morphine-like action in the body. ... In chemistry, analogs or analogues are compounds in which one or more individual atoms have been replaced, either with a different atom, or with a different functional group. ... Imodium redirects here. ... On opiod agonist used for the treatment of diarrhea. ... For the band, see Codeine (band). ...

Laxatives

Main article: laxative

For patients who do not adequately respond to dietary fiber, osmotic agents such as polyethylene glycol, sorbitol, and lactulose can help avoid 'cathartic colon' which has been associated with stimulant laxatives.^[83] Among the osmotic laxatives, 17 to 26 grams/day of polyethylene glycol (PEG) has been well studied. Laxatives (or purgatives) are foods, compounds, or drugs taken to induce bowel movements or to loosen the stool, most often taken to treat constipation. ... Dietary fibers are the indigestible portion of plant foods that move food through the digestive system, absorbing water and making defecation easier. ... Polyethylene glycol (PEG) and polyethylene oxide (PEO) are polymers composed of repeating subunits of identical structure, called monomers, and are the most commercially important polyethers. ... Sorbitol, also known as glucitol, is a sugar alcohol the body metabolises slowly. ... Lactulose is a synthetic sugar used in the treatment of constipation and hepatic encephalopathy, a complication of liver disease. ... Polyethylene glycol (PEG) and polyethylene oxide (PEO) are polymers composed of repeating subunits of identical structure, called monomers, and are the most commercially important polyethers. ...

Antispasmodics

Main article: antispasmodic

The use of antispasmodic drugs (e.g. anticholinergics such as hyoscyamine or dicyclomine) may help patients, especially those with cramps or diarrhea. A meta-analysis by the Cochrane Collaboration concludes that if 6 patients are treated with antispasmodics, 1 patient will benefit (number needed to treat = 6).^[80] Antispasmodics can be divided in two groups: neurotropics and musculotropics. Neurotropics, such as atropine, act at the nerve fibre of the parasympathicus but also affect other nerves and have side effects. Musculotropics such as mebeverine act directly at the smooth muscle of the gastrointestinal tract, relieving spasm without affecting normal gut motility. Since this action is not mediated by the autonomic nervous system, the usual anticholinergic side effects are absent. Antispasmodic drugs are also available in combination with tranquilizers or barbiturates, such as chlordiazepoxide and Donnatal. The value of the combination therapies has not been established. An antispasmodic is a drug that suppresses smooth muscle contraction, especially in tubular organs. ... An anticholinergic agent is a member of a class of pharmaceutical compounds which serve to reduce the effects mediated by acetylcholine in the central nervous system and peripheral nervous system. ... Hyoscyamine is a chemical compound, a tropane alkaloid it is the levo-isomer to atropine. ... Dicyclomine is an anticholinergic that blocks muscarinic receptors. ... A meta-analysis is a statistical practice of combining the results of a number of studies. ... The Cochrane Collaboration developed in response to Archie Cochranes call for systematic, up-to-date reviews (currently known as systematic reviews) of all relevant randomized clinical trials of health care. ... The number needed to treat (NNT) is an epidemiological measure that indicates how many patients would require treatment with a form of medication to reduce the expected number of cases of a defined endpoint by one. ... Atropine is a tropane alkaloid extracted from the deadly nightshade (Atropa belladonna) and other plants of the family Solanaceae. ... Mebeverine HCI is a musculotropic antispasmodic drug without atropic side-effects whose major therapeutic role is in the treatment of irritable bowel syndrome. ... A sedative is a drug that depresses the central nervous system (CNS), which causes calmness, relaxation, reduction of anxiety, sleepiness, slowed breathing, slurred speech, staggering gait, poor judgment, and slow, uncertain reflexes. ... Barbiturates are drugs that acts as central nervous system (CNS) depressants, and by virtue of this they produce a wide spectrum of effects, from mild sedation to anesthesia. ... Chlordiazepoxide (pronounced [ˈklɔːrˌdaɪəzepˈoksaɪd], marketed under the trade name Librium®) is a sedative/hypnotic drug which is a benzodiazepine derivative. ... Donnatal is a proprietary combination medication for the treatment of intestinal cramping due to various causes. ...

Drugs affecting serotonin

Drugs affecting serotonin (5-HT) in the intestines can help reduce symptoms.^[84] Serotonin stimulates the gut motility and so agonists can help constipation predominate irritable bowel while antagonists can help diarrhea predominant irritable bowel: For the professional wrestling stable, see Ravens Nest#Serotonin. ...

Agonists

• Tegaserod, a selective 5-HT4 agonist for IBS-C, is available for relieving IBS constipation in women and chronic idiopathic constipation in men and women. On March 30, 2007, the Food and Drug Administration (FDA) requested that Novartis Pharmaceuticals voluntarily discontinue marketing of Zelnorm (tegaserod) based on the recently identified finding of an increased risk of serious cardiovascular adverse events (heart problems) associated with use of the drug. Novartis agreed to voluntarily suspend marketing of the drug in the United States and in many other countries. On July 27, 2007 the Food and Drug Administration (FDA) approved a limited treatment IND program for Zelnorm in the USA to allow restricted access to the medication for patients in need if no comparable alternative drug or therapy is available to treat the disease. The USA FDA had issued two previous warnings about the serious consequences of Tegaserod. In 2005, Tegaserod was rejected as an IBS medication by the European Union. Tegaserod, marketed as Zelnorm in the United States, was the only agent approved to treat the multiple symptoms of IBS (in women only), including constipation, abdominal pain and bloating. A meta-analysis by the Cochrane Collaboration concludes that if 17 patients are treated with typical doses of tegaserod, 1 patient will benefit (number needed to treat = 17).^[85]
• Selective serotonin reuptake inhibitor anti-depressants (SSRIs), because of their serotonergic effect, would seem to help IBS, especially patients who are constipation predominant. Initial crossover studies^[86] and randomized controlled trials^[87][88][89] support this role.

Tegaserod is a 5-HT4 agonist used for the management of constipation-predominant irritable bowel syndrome (IBS). ... A meta-analysis is a statistical practice of combining the results of a number of studies. ... The Cochrane Collaboration developed in response to Archie Cochranes call for systematic, up-to-date reviews (currently known as systematic reviews) of all relevant randomized clinical trials of health care. ... Tegaserod is a 5-HT4 agonist used for the management of constipation-predominant irritable bowel syndrome (IBS). ... The number needed to treat (NNT) is an epidemiological measure that indicates how many patients would require treatment with a form of medication to reduce the expected number of cases of a defined endpoint by one. ... SSRI redirects here; for other uses, see SSRI (disambiguation). ... An antidepressant is a medication used primarily in the treatment of clinical depression. ... A crossover trial is one where patients are given all of the medications to be studied in random order. ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicine, used because of its record of reliability. ...

Antagonists

• Alosetron, a selective 5-HT3 antagonist for IBS-D, which is only available for women in the United States under a restricted access program, due to severe risks of side-effects if taken mistakenly by IBS-A or IBS-C sufferers.
• Cilansetron, also a selective 5-HT3 antagonist, is undergoing further clinical studies in Europe for IBS-D sufferers. In 2005, Solvay Pharmaceuticals withdrew Cilansetron from the United States regulatory approval process after receiving a "not approvable" action letter from the FDA requesting additional clinical trials.

Alosetron is a 5-HT3 antagonist used for the management of severe diarrhoea-predominant irritable bowel syndrome (IBS) in women only. ... An adverse drug reaction (abbreviated ADR) or adverse drug event (abbreviated ADE) is an expression that describes the unwanted, negative consequences associated with the use of given medications. ... Cilansetron (Pronounced Sil-an-set-ron) is a drug that is a 5HT-3 antagonist currently under trial phase in the EU and US it is manufactured by Solvay Pharmacuticals INC. 5HT-3 receptors are responsible for causing many things from nausea to excess bowel movements. ...

Other agents

Anti-depressants include both tricyclic antidepressants (TCAs) and the newer selective serotonin reuptake inhibitors (SSRIs). In addition to improving symptoms via treating any co-existing depression, TCAs have anti-cholinergic actions while SSRIs are serotonergic. Thus in theory, TCAs would best treat diarrhea-predominant IBS while SSRIs would best treat constipation-predominant IBS. A meta-analysis of randomized controlled trials of mainly TCAs found 3 patients have to be treated with TCAs for one patient to improve (number needed to treat = 3).^[90] A separate randomized controlled trial found that TCAs are best for patients with diarrhea-predominant IBS.^[91] Chemical structure of the tricyclic antidepressant amitriptyline Tricyclic antidepressants are a class of antidepressant drugs first used in the 1950s. ... Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants. ... A meta-analysis is a statistical practice of combining the results of a number of studies. ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicine, used because of its record of reliability. ... The number needed to treat (NNT) is an epidemiological measure that indicates how many patients would require treatment with a form of medication to reduce the expected number of cases of a defined endpoint by one. ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicines or medical procedures. ...

Recent studies have suggested that rifaximin can be used as an effective treatment for abdominal bloating and flatulence,^[92][47] giving more credibility to the potential role of bacterial overgrowth in some patients with IBS.^[93] Rifaximin Xifaxan Rifaximin is a nonabsorbable antibiotic, meaning that the drug will not pass the gastrointestinal wall into the circulation as is common for other types of orally administered antibiotics. ... Flatulence is the presence of a mixture of gases in the digestive tract of mammals. ...

The multi-herbal extract Iberogast was found to be significantly superior to placebo via both an abdominal pain scale and an IBS symptom score after four weeks of treatment.^[94]

Enteric coated peppermint oil capsules has been advocated for IBS symptoms in adults and children;^[95] however, results from trials have been inconsistent.^[96][97] Binomial name Mentha × piperita L. Peppermint (Mentha × piperita) is a (usually) sterile hybrid mint, a cross between watermint (Mentha aquatica) and spearmint (Mentha spicata). ...

For severe diarrhea-predominant IBS, more potent opioids may be used, such as codeine or propoxyphene; refractory cases may even be treated with paregoric, or, more rarely, deodorized tincture of opium or morphine sulfate. The use of opioids remains controversial due to the lack of evidence supporting their benefit and the potential risk of tolerance, physical dependence and addiction.^[98] An opioid is any agent that binds to opioid receptors found principally in the central nervous system and gastrointestinal tract. ... For the band, see Codeine (band). ... Dextropropoxyphene is an analgesic in the opioid category that is used to treat severe pain and severe coughs. ... Paregoric, or camphorated tincture of opium, is a medication known for its antidiarrheal, antitussive, and analgesic properties. ... This article is about the medicine. ... Morphine (INN), the principal active agent in opium, is a powerful opioid analgesic drug. ... It has been suggested that toleration be merged into this article or section. ... Physical dependence refers to a state resulting from habitual use of a drug, where negative physical withdrawal symptoms result from abrupt discontinuation. ... This article is about the concept of addiction. ...

Cannabis has theoretical support for its role,^[99][100] but has not been subject of clinical studies. Although illegal in many counties, it has been prescribed to patients in nations such as Canada. Some of the argued benefits of cannabis are the reduction of pain and nausea, appetite stimulation, and assisting in falling asleep. This article is about the plant genus Cannabis. ...

Psychotherapy and hypnotherapy

There is a strong brain-gut component to IBS, and cognitive therapy may improve symptoms in a portion of patients in conjunction with antidepressants.^[101] In a randomized controlled trial of referred patients, cognitive behavioral therapy helped even though patients in this study did not have any psychiatric diagnoses.^[102] This article is about Becks Cognitive Therapy. ... Prozac, a selective serotonin reuptake inhibitor (SSRI) Serotonin-norepinephrine reuptake inhibitor, Venlafaxine An antidepressant is a psychiatric medication or other substance (nutrient or herb) used for alleviating depression or dysthymia (milder depression). ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicines or medical procedures. ... A Cognitive Behavioral Therapy (CBT) is a psychotherapy based on modifying cognitions, assumptions, beliefs and behaviors, with the aim of influencing disturbed emotions. ...

Gut-directed or gut-specific hypnotherapy or self-hypnosis is one of the most promising areas of IBS treatment. An uncontrolled study shows that symptom reduction/elimination from IBS hypnotherapy can last at least five years.^[103] Hypnotherapy is therapy that is undertaken with a subject in hypnosis. ...

Relaxation therapy in four 90-minute group sessions was found to help in a randomized controlled trial.^[104] A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicines or medical procedures. ...

Alternative treatments

Probiotics

Probiotics are generally accepted to be potentially beneficial strains of bacteria and yeast, often found in the human gut. One research study has shown a clear link between the ingestion of Lactobacillus plantarum 299v (Lp299v) and sufferers of IBS who reported resolution of their abdominal pain.^[105] Another study showed the utility of B. infantis 35625, a strain of Bifidobacteria, in normalizing bowel movement frequency in sufferers of IBS.^[106] Some practitioners of Integrative Medicine now recommend a strain of Lactobacillus rhamnosus known commonly as "LGG" after its discoverers Gorbach and Goldin. This strain in particular has shown an ability to endure the acidic environment of the stomach and survive until presentation to the intestinal tract. Probiotics are dietary supplements containing potentially beneficial bacteria. ... Phyla Actinobacteria Aquificae Chlamydiae Bacteroidetes/Chlorobi Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Lentisphaerae Nitrospirae Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Verrucomicrobia Bacteria (singular: bacterium) are unicellular microorganisms. ... Typical divisions Ascomycota (sac fungi) Saccharomycotina (true yeasts) Taphrinomycotina Schizosaccharomycetes (fission yeasts) Basidiomycota (club fungi) Urediniomycetes Sporidiales Yeasts are a growth form of eukaryotic micro organisms classified in the kingdom Fungi, with about 1,500 species described;[1] they dominate fungal diversity in the oceans. ... Binomial name Lactobacillus plantarum (Orla-Jensen 1919) Bergey 1923 Lactobacillus plantarum is a widespread member of the genus Lactobacillus, commonly found in sauerkraut, pickles, brined olives, korean kimchi, nigerian ogi, sourdugh and other fermented plant material and also in some cheeses and fermented sausages. ... A bacterial group (and probiotic) that is perceived to exert health-promoting properties within humans, specifically the colon. ... Integrative medicine, as defined by NCCAM, combines conventional medical treatments and CAM alternative treatments for which there is some high-quality scientific evidence of their safety and effectiveness. ... Previously, this was considered a subspecies of Lactobacillus casei. ...

A prospective placebo-controlled study found patients with diarrhea predominant IBS taking Saccharomyces boulardii, a probiotic yeast, had a significant reduction on the number and improvement in consistency of bowel movements.^[107] Binomial name Saccharomyces boulardii Henri Boulard Saccharomyces boulardii is a tropical strain of yeast first isolated from lychee and mangosteen fruit in 1923 by French scientist Henri Boulard. ... Typical divisions Ascomycota (sac fungi) Saccharomycotina (true yeasts) Taphrinomycotina Schizosaccharomycetes (fission yeasts) Basidiomycota (club fungi) Urediniomycetes Sporidiales Yeasts are a growth form of eukaryotic micro organisms classified in the kingdom Fungi, with about 1,500 species described;[1] they dominate fungal diversity in the oceans. ...

Acupuncture

Many sufferers of IBS seek relief using Acupuncture, a component of Traditional Chinese Medicine. The meta-analysis by the Cochrane Collaboration concluded 'Most of the trials included in this review were of poor quality and were heterogeneous in terms of interventions, controls, and outcomes measured. With the exception of one outcome in common between two trials, data were not combined. Therefore, it is still inconclusive whether acupuncture is more effective than sham acupuncture or other interventions for treating IBS'.^[108] One practitioner of Traditional Chinese Medicine asserts that IBS has become a bit of a "garbage diagnosis" for some medical practitioners. Traditional Chinese Medicine does not recognize the Western diagnosis of IBS per se, as the named condition has no definitive single test for diagnosis, clear cause, or cure. Traditional Chinese Medicine approaches IBS on an individual symptom-by-symptom basis, rather than recognizing a standard "IBS" diagnosis, which then warrants a blanket "IBS" treatment.^[109] According to the National Institutes of Health, "Preclinical studies have documented acupuncture's effects, but they have not been able to fully explain how acupuncture works within the framework of the Western system of medicine that is commonly practiced in the United States."^[110] Acupuncture chart from Hua Shou (fl. ... Traditional Chinese medicine shop in Tsim Sha Tsui, Hong Kong. ... A meta-analysis is a statistical practice of combining the results of a number of studies. ... The Cochrane Collaboration developed in response to Archie Cochranes call for systematic, up-to-date reviews (currently known as systematic reviews) of all relevant randomized clinical trials of health care. ...

Geographics

By Country: Studies have reported that the prevalence of IBS varies by country and by age range examined. The bar graph at right shows the percentage of the population reporting symptoms of IBS in studies from various geographic regions (see table below for references). Image File history File links No higher resolution available. ... Image File history File links No higher resolution available. ...

The following table contains a list of studies performed in different countries that measured the prevalence of IBS and IBS-like symptoms:

Returning Travelers: A study of United States residents returning from international travel found a high rate of IBS and persistent diarrhea which developed during travel and persisted upon return. The study examined 83 subjects in Utah, most of whom were returning missionaries. Of the 68 who completed the gastrointestinal questionnaire, 27 reported persistent diarrhea that developed while traveling, and 10 reported persistent IBS that developed while traveling.^[119]

Economic cost of IBS

The aggregate cost of irritable bowel syndrome in the United States has been estimated at $1.7-$10 billion in direct medical costs, with an additional $20 billion in indirect costs, for a total of $21.7-$30 billion.^[120] A study by a managed care company comparing medical costs of IBS patients to non-IBS controls identified a 49% annual increase in medical costs associated with a diagnosis of IBS.^[121] A 2007 study from a managed care oganization found that IBS patients incurred average annual direct costs of $5,049 and $406 in out-of-pocket expenses.^[122]A study of workers with IBS found that they reported a 34.6% loss in productivity, corresponding to 13.8 hours lost per 40 hour week.^[123] A study of employer-related health costs from a Fortune 100 company conducted with data from the 1990's found IBS patients incurred US $4527 in claims costs vs. $3276 for controls.^[124] A study on Medicaid costs conducted in 2003 by the University of Georgia's College of Pharmacy and Novartis found IBS was associated in an increase of $962 in Medicaid costs in California, and $2191 in North Carolina. IBS patients had higher costs for physician visits, outpatients visits, and prescription drugs. The study suggested the costs associated with IBS were comparable to those found in asthma patients.^[125] Novartis headquarters in Basel Suffern, New York: the sole Novartis pharmaceutical production facility in the United States. ...

Research spending on IBS

Further information: NIH funding of IBS Research

The National Institutes of Health provides a searchable database for grant awards since 1974 on its CRISP database, and provides dollar amounts for recent awards on its Intramural Grant Award Page. In 2006, the NIH awarded approximately 56 grants related to IBS, totalling approximately $18,787,710. // In the United States, the National Institutes of Health is the largest single entity providing funding for biomedical research. ... National Institutes of Health Building 50 at NIH Clinical Center - Building 10 The National Institutes of Health (NIH) is an agency of the United States Ministry of Health and Human Services and is the primary agency of the United States government responsible for biomedical and health-related research. ... The CRISP thesaurus maintained by the Office of Extramural Research at the National Institutes of Health is a public domain collection of lists with the terms used in biological and medical research. ...

Summary

IBS does not lead to more serious conditions in most patients.^{[16][17][18][19][20]} But it is a source of chronic pain, fatigue and other symptoms, and it increases a patient's medical costs,^[122][121] and contributes to work absenteeism.^[123][126] Researchers have reported that the high prevalence of IBS,^{[111][114][118]} in conjunction with increased costs produces a disease with a high societal cost.^[120]

See also

• Hydrogen breath test

A Hydrogen Breath Test (or HBT) is used as a clinical medical diagnosis for people with irritable bowel syndrome, and common food intolerances. ...

References

A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Fibromyalgia (FM) is stated to be a disorder classified by the presence of chronic widespread pain and tactile allodynia. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Fibromyalgia (FM) is stated to be a disorder classified by the presence of chronic widespread pain and tactile allodynia. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... is the 286th day of the year (287th in leap years) in the Gregorian calendar. ... Year 2003 (MMIII) was a common year starting on Wednesday of the Gregorian calendar. ... is the 287th day of the year (288th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... 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A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

External links

• Irritable bowel syndrome at the Open Directory Project