Irritable Bowel Syndrome (IBS)
About the disease & condition
Aetiology & Pathophysiology
Aetiology:** Multifactorial; contributions from gut-brain axis dysregulation, visceral hypersensitivity, altered gut motility, intestinal microbiota changes, and psychosocial factors (e.g., stress, anxiety).
Pathophysiology:** Abnormalities in gut-brain communication lead to heightened pain perception (visceral hypersensitivity), dysmotility, and immune activation with low-grade inflammation in some cases.
Symptoms & Signs
Common symptoms:**
- Recurrent abdominal pain or discomfort relieved by defecation.
- Altered stool frequency or form (e.g., loose/watery or hard/lumpy stools).
- Bloating, distension, and mucus in stool.
Subtypes:** IBS-D (diarrhoea-predominant), IBS-C (constipation-predominant), IBS-M (mixed).
Red-flag symptoms (suggestive of organic disease):**
- Unintended weight loss, nocturnal symptoms, fever, rectal bleeding, anaemia, family history of colorectal cancer or inflammatory bowel disease.
Diagnosis
Clinical diagnosis:** Based on Rome IV criteria (recurrent abdominal pain ≥1 day/week for ≥3 months, associated with ≥2 of: related to defecation, change in stool frequency, change in stool form).
Exclusion of alarm features:** Guide needs further testing.
Limited testing (as indicated):**
- CBC, CRP, ESR, celiac serology, thyroid function tests.
- Faecal calprotectin (to distinguish from IBD).
- Colonoscopy (if alarm features, age >50, or family history of colorectal cancer).
Management
Non-pharmacological:**
- Dietary modifications: Low FODMAP diet (fermentable oligo-, di-, monosaccharides, and polyols), fibre supplementation (e.g., psyllium).
- Stress reduction: Cognitive behavioural therapy, gut-directed hypnotherapy, and regular exercise.
Pharmacological (symptom-targeted):**
-
- Antispasmodics (e.g., hyoscine, dicyclomine) for pain.
- Antidiarrheals (e.g., loperamide) for IBS-D.
- Laxatives (e.g., polyethene glycol) for IBS-C.
- Gut-specific neuromodulators (e.g., tricyclic antidepressants, SSRIs) for pain and global symptoms.
- Rifaximin (for IBS-D with bloating), lubiprostone/linaclotide (for IBS-C).
Potential Complications
- Reduced quality of life:** Chronic pain, anxiety, depression, social and occupational impairment.
- Nutritional deficiencies** (if dietary restrictions are overly stringent).
- Unnecessary procedures** due to misdiagnosis or overlapping symptoms.
Prevention & Follow-up
Prevention:** No known prevention; stress management and healthy diet may reduce flare-ups.
Follow-up:**
- Regular monitoring of symptoms and treatment response.
- Reassessment if new alarm features develop or symptoms change significantly.
- Long-term focus on symptom control and quality of life rather than cure.
Relevant Specialities
Gastroenterology
Our Gastrosciences service diagnoses and treats conditions of the digestive system such as the oesophagus, stomach, small intestine, colon, liver, pancreas and bile ducts. Our team of gastroenterologists, hepatologists and specialist nurses use advanced, minimally invasive techniques to give precise care. POEM (Peroral Endoscopic Myotomy) treats oesophageal motility disorders, ESD to remove early tumours without open surgery, ERCP and SpyGlass for bile-duct problems, EndoVAC for closing leaks, STER for subepithelial tumours, and capsule endoscopy to image the small intestine. We also perform diagnostics and therapeutic endoscopy (OGD, colonoscopy, EUS, manometry, pH studies) and offer stenting, polypectomy, dilation, variceal therapy and biliary drainage as needed. In addition, age appropriate diagnostics and transplant-linked care are provided with dietitians and psychological support built into long-term plans.
