Irritable Bowel Syndrome (IBS)

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Irritable Bowel Syndrome (IBS)

Topic Overview

What is irritable bowel syndrome (IBS)?

Illustration of the lower digestive system

Irritable bowel syndrome (IBS) is a disorder of the intestines. It causes belly pain, cramping or bloating, and diarrhea or constipation. Irritable bowel syndrome is a long-term problem, but there are things you can do to reduce your symptoms.

Your symptoms may be worse or better from day to day, but your IBS will not get worse over time. IBS does not cause more serious diseases, such as inflammatory bowel disease or cancer.

What causes IBS?

It is not clear what causes irritable bowel syndrome, and the cause may be different for different people. Some ideas for what causes IBS include problems with the way signals are sent between the brain and the digestive tract, problems digesting certain foods, and stress or anxiety. People with IBS may have unusually sensitive intestines or problems with the way the muscles of the intestines move.

For some people with IBS, certain foods, stress, hormonal changes, and some antibiotics may trigger pain and other symptoms.

What are the symptoms?

The main symptoms of irritable bowel syndrome are belly pain with constipation or diarrhea. Other common symptoms are bloating, mucus in the stools, or a feeling that you have not completely emptied your bowels.

Many people with IBS go back and forth between having constipation and having diarrhea. For most people, one of these happens more often than the other.

IBS is quite common. Most people's symptoms are so mild that they never see a doctor for treatment. But some people may have troublesome symptoms, especially stomach cramps, bloating, and diarrhea.

How is IBS diagnosed?

Most of the time, doctors can diagnose irritable bowel syndrome from the symptoms. Your doctor will ask you about your symptoms and past health and will do a physical exam.

In some cases, you may need other tests, such as stool analysis or blood tests. These tests can help your doctor rule out other problems that might be causing your symptoms.

How is it treated?

Irritable bowel syndrome is a long-term condition, but there are things you can do to manage your symptoms. Treatment usually includes making changes in your diet and lifestyle, such as avoiding foods that trigger your symptoms, getting regular exercise, and managing your stress.

There are also medicines that may help with your symptoms. If diet and lifestyle changes do not help enough on their own, your doctor may prescribe medicines for pain, diarrhea, or constipation.

Frequently Asked Questions

Learning about IBS:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with IBS:

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Cause

The exact cause of irritable bowel syndrome (IBS) is not known. But health experts believe faulty communication between the brain and the intestinal tract causes the symptoms of IBS.

A complex combination of elements, including psychological stress, hormones, the immune system, and chemicals called neurotransmitters, appears to interfere with messages between the brain and the bowel. The miscommunication causes abnormal muscle contractions or spasms, which often cause cramping pain. The spasms may either speed the passage of stool, causing diarrhea, or slow it down, causing constipation or bloating.

People who have IBS seem to have unusually sensitive intestines. It is not known why their intestines are more likely to react strongly to the elements that contribute to IBS. People who have IBS may start having symptoms because of one or more factors, including:

  • Eating (though no particular foods have been associated with IBS).
  • Stress. Stress may affect the movements of the intestines and also may affect the way a person feels pain. (Stress may also have the same effect on people who do not have IBS.)
  • Trapped gas that causes bloating.
  • Hormonal changes, such as during the menstrual cycle.
  • Some medicines, such as antibiotics.
  • Genetics. IBS may be more likely to occur in people who have a family history of the disorder.

Symptoms

An expert panel has outlined a list of symptoms common in irritable bowel syndrome (IBS). Doctors often use this list of symptoms, known as the Rome III criteria, to distinguish IBS from other intestinal problems. But people who don't have all of these symptoms may still have IBS.

You meet the Rome III criteria for IBS if your symptoms began at least 6 months ago, you have had abdominal pain or discomfort at least 3 days each month in the last 3 months, and at least two of the following statements are true:7

  • The pain is relieved by having a bowel movement.
  • The pain is linked to a change in how often you have a bowel movement.
  • The pain is linked to a change in the appearance or consistency of your stool.

The presence of any of the following symptoms supports a diagnosis of IBS.

Bowel movement patterns

When you have IBS, your pattern of bowel movements may be different over time. Two or more of the following may happen:

  • Bowel movements may occur either more often (diarrhea) or less often (constipation) than usual, such as having more than 3 bowel movements a day or less than 3 a week.
  • Bowel movements may differ in size or consistency (may be hard and small, pencil-thin, or loose and watery).
  • The way stools pass changes. You may strain, feel an urgent need to have a bowel movement, or feel that you haven't completely passed a stool.
  • You may have bloating or a feeling of gas in the intestines.

Other intestinal symptoms

Some people may have lower abdominal pain with constipation that is sometimes followed by diarrhea. Other people have pain and mild constipation but no diarrhea.

Symptoms that are sometimes present include intestinal gas and passage of mucus in stools.

Nongastrointestinal symptoms

You may sometimes have other symptoms that don't affect the intestines, such as:

  • Anxiety or depression.
  • Fatigue.
  • Headache.
  • Unpleasant taste in the mouth.
  • Backache.
  • Sleeping problems (insomnia) not caused by symptoms of IBS.
  • Sexual problems, such as pain during sex or reduced sexual desire.
  • Heart palpitations (feeling like the heart skips a beat or is fluttering).
  • Urinary symptoms (frequent or urgent need to urinate, trouble starting the urine stream, trouble emptying the bladder).

Symptoms often occur after a meal, during stressful times, or during menstruation.

There are many other conditions with symptoms similar to IBS.

What Happens

Symptoms of irritable bowel syndrome (IBS) may persist for a long time, but IBS does not cause cancer or shorten life expectancy.

The pattern of IBS varies from one person to the next and from one bout to the next. Some people have symptoms off and on for many years. You may go months or years without having any symptoms. However, most people have recurrent episodes of symptoms. It is rare for a person to have symptoms constantly.

As people get older, their symptoms of IBS tend to get better. And over time about 3 out of 10 people will stop having any symptoms at all.4

Although IBS does not cause more serious conditions, such as cancer or inflammatory bowel disease, a person who has IBS may also have one of these illnesses.

What Increases Your Risk

Between 7% and 10% of people in the world have irritable bowel syndrome.3 But most people with IBS don't see a doctor about their symptoms.

IBS tends to be more common in:

  • People in their late 20s.
  • Women.
  • People who have panic disorder or other psychological conditions.
  • People who have a family history of IBS.
  • People who have a history of physical or sexual abuse or other psychological trauma. Several studies have found a link between a past history of abuse and gastrointestinal disorders.1
  • People with other conditions such as depression, migraine headaches, and fibromyalgia (which causes widespread muscle and soft-tissue pain and tenderness).

When To Call a Doctor

Call your doctor or other health professional if:

  • You have been diagnosed with irritable bowel syndrome (IBS) and your symptoms become worse, begin to disrupt your activities, or do not respond as usual to your home treatment.
  • You are becoming more tired than usual.
  • Your symptoms wake you from sleep.
  • You have unexplained weight loss.
  • You have decreased appetite.
  • You have abdominal pain that is not associated with changes in bowel function or that is not relieved when you pass gas or a stool.
  • You have abdominal pain that is now in one area (localized) more than any other area.
  • You see blood in your stool.

Watchful Waiting

Watchful waiting is not appropriate if you have any "alarm symptoms," which could mean a serious problem. Alarm symptoms include:

  • Fever.
  • Unexplained weight loss.
  • Blood in your stools.
  • Anemia, which is a decrease in the amount of oxygen-carrying substance (hemoglobin) found in red blood cells.
  • Family history of colon cancer or inflammatory bowel disease, which causes chronic inflammation of the intestines.

If none of the symptoms listed above is present, try to rule out other causes of abdominal problems, such as eating a new food; eating sugar-rich foods, especially milk products; eating foods containing sorbitol or other artificial sweeteners; nervousness; or stomach flu. Try home treatment for 1 or 2 weeks. If your symptoms don't get better or if they get worse, call your health professional.

An occasional case of upset stomach, diarrhea, or constipation is common, especially during stressful times. Symptoms of stomach pain, nausea, vomiting, and diarrhea that come on quickly and that go away on their own are more likely to be caused by stomach flu or food poisoning, especially if other people around you are also sick.

Who To See

The following health professionals can diagnose and treat irritable bowel syndrome (IBS).

If more tests are needed or your symptoms do not respond to initial therapy, it may be helpful to see a doctor who specializes in treating digestive system problems (gastroenterologist). If stress may be playing a role in IBS, it may be helpful to see a psychiatrist or psychologist.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Irritable bowel syndrome (IBS) can be diagnosed based on symptoms. In most cases, only minimal tests are needed. A health professional diagnoses IBS when a person has the typical symptoms of the disorder and, if needed, tests have ruled out other possible causes.

The amount of testing that may be done depends on several factors: your age, how your symptoms come on and how severe they are, and how you respond to the initial treatment. For example:

  • For a 20-year-old woman who has all the typical symptoms of IBS, a routine blood test may be the only test needed. Irritable bowel syndrome is more common in young women, and so if symptoms are typical of IBS, extensive testing is probably not needed.
  • For a 55-year-old man whose symptoms started recently, more extensive testing is probably needed. People over age 50 are less likely than younger people to develop IBS symptoms for the first time, so it is more likely that symptoms may be caused by another problem.
  • If you get better after some initial treatment for symptoms that the health professional suspects are caused by IBS, no further tests are needed.

Depending on your symptoms, results of the initial tests, or your response to treatment, other tests may be done.

Click here to view a Decision Point. Irritable Bowel Syndrome: Should I Have Tests for IBS Symptoms?

Tests may include:

Thyroid function tests and imaging tests, such as colonoscopy, are occasionally done.

Treatment Overview

Irritable bowel syndrome (IBS) is a long-term (chronic) but manageable condition. Treatment will depend on the types of symptoms you have and their severity, as well as how they affect your daily life, and will likely involve changes to your lifestyle. It is important that you work closely with your doctor to create a treatment plan that will meet your needs. Learn all you can about your condition so you can effectively communicate concerns and questions to your doctor.

Initial treatment

No single type of treatment for irritable bowel syndrome works best for everyone. You and your doctor will need to work together to determine what may be triggering your symptoms. It will be necessary for you to adapt your lifestyle to best deal with your symptoms and still carry on with your daily activities. Let your doctor know if parts of your treatment are not helping your symptoms.

For some people who have IBS, certain foods may trigger symptoms. The following suggestions may help prevent or relieve some IBS symptoms:

  • Avoid caffeine and alcohol.
  • Limit your intake of fatty foods.
  • If diarrhea is your main symptom, limit dairy products, fruit, and artificial sweeteners such as sorbitol or xylitol.
  • Increasing fiber in your diet may help relieve constipation.
  • Avoiding foods such as beans, cabbage, or uncooked cauliflower or broccoli can help relieve bloating or gas.
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Getting regular, vigorous exercise (such as swimming, jogging, or brisk walking) may help reduce tension and make your bowels more regular.

Medicines may be used along with lifestyle changes to manage symptoms of IBS. Medicines for IBS may include anticholinergics for cramping, medicines for diarrhea or constipation, antidepressants, or antianxiety drugs.

If stress triggers your symptoms, some form of psychological therapy or stress management may help you deal more positively with stress and help prevent or reduce stress-related IBS episodes.

Ongoing treatment

Treatment for irritable bowel syndrome (IBS) usually involves long-term management of your symptoms. It is important that you have a good working relationship with your doctor to monitor your symptoms and identify changes in your diet and lifestyle that can help relieve the symptoms. Keeping a journal of your symptoms can help you identify triggers that make symptoms worse.

Be especially aware of significant changes in symptoms, such as the appearance of blood in your stools, increased pain, severe fever, or unexplained weight loss. If any of these occur, your doctor may want to conduct additional tests to determine whether there is another cause for your symptoms.

In treating chronic IBS, be sure to maintain the changes to lifestyle and diet that relieve symptoms. Quitting smoking, avoiding caffeine and foods that make symptoms worse, and getting regular exercise should all be permanent parts of your daily routine.

Click here to view an Actionset. Irritable Bowel Syndrome: Controlling Symptoms With Diet

You will likely continue to take medicines as needed to treat your symptoms.

Because IBS often results from a combination of physical and stress-related factors, a treatment approach that addresses both these causes will be most successful. In addition to treating constipation or diarrhea with medicines and changes to diet and lifestyle, stress management or other psychological therapy should be a major part of your treatment plan.

Treatment if the condition gets worse

If your symptoms get worse, your doctor will likely conduct more tests to determine whether there is another cause for your symptoms. Irritable bowel syndrome (IBS) does not lead to more serious conditions, such as cancer or inflammatory bowel disease, but a person with IBS may also have one of these illnesses.

Your doctor may also want you to try different medicines, or different dosages of your current medicines, if your symptoms are not responding to treatment.

Prevention

You cannot prevent irritable bowel syndrome (IBS). But proper self-care may help minimize symptoms and perhaps extend the time between episodes. This includes quitting smoking, avoiding caffeine and foods that make symptoms worse, and getting regular exercise.

Home Treatment

For most people who have irritable bowel syndrome (IBS), home treatment may be the best way to manage the symptoms. It is also helpful to learn all you can about IBS so you can effectively communicate concerns and questions to your doctor.

Although there currently is no cure for IBS, careful attention to diet and stress management should help keep your symptoms under control and perhaps even prevent them from coming back.

Diet modification

In many people who have IBS, eating may trigger symptoms. But for most people, there is not a particular type of food that triggers symptoms.

Increasing the amount of fiber in your diet can help control constipation. High-fiber foods include fresh fruits (raspberries, pears, apples), fresh vegetables (peas, brussels sprouts), wheat bran, and whole-grain breads and cereals. Beans such as kidney, pinto, and garbanzo are also high-fiber foods, but they should probably be avoided if gas is one of your symptoms.

If you have trouble getting enough fiber in your diet, you can take a fiber supplement, such as psyllium (for example, Metamucil). If you take a fiber supplement, start with a small dose and very slowly increase the dose over a month or more. Also, make sure you drink plenty of fluids, enough so that your urine is light yellow or clear like water.

You can take steps to reduce the possibility that certain foods will cause symptoms, such as avoiding or limiting gas-producing foods (including beans and cabbage), sugarless chewing gum and candy, caffeine, and alcohol.

Click here to view an Actionset. Irritable Bowel Syndrome: Controlling Symptoms With Diet

Stress management

If stress seems to trigger your symptoms, the following may help you better manage stress and avoid or ease some IBS episodes:

  • Keep a diary or journal of your symptoms as well as life events that occur with them. This often helps clarify the connection between symptoms and stressful occasions. After you have identified certain events or situations that bring on symptoms, you can develop ways of dealing with these situations.
  • Get regular, vigorous exercise (such as swimming, jogging, or brisk walking) to help reduce tension.
  • A hobby or an outside activity can provide a break from stressful situations.
  • Psychiatrists, psychologists, hypnotists, counselors, social workers, and biofeedback specialists can provide methods for coping with stress.

Because there are no structural problems in the intestines of people who have IBS, some people may think this means that the symptoms "are all in their head." This is not true. The pain, discomfort, and bloating are real and have many different causes that can be addressed to help relieve symptoms.

While the symptoms are quite real, psychological factors often play a role in the development of IBS. People who have IBS are more likely than people without the condition to have depression, panic disorder, or other psychological conditions.7 Acknowledging these factors may help you and your doctor successfully manage your condition.

Medications

Medicine may be used along with lifestyle changes to manage symptoms of irritable bowel syndrome (IBS).

The goal of medicine treatment is to relieve your symptoms enough to prevent them from interfering with your daily activities, because it may not be possible to eliminate your symptoms. Medicines may be prescribed to treat moderate to severe pain, diarrhea, or constipation that does not respond to home treatment. No single medicine has been shown to be effective in relieving IBS over the long term.

Medication Choices

In most cases, the choice of medicine is based on your most troublesome symptom. For example, if diarrhea is the most bothersome symptom, using antidiarrheals or anticholinergics may be helpful.

For diarrhea

Medicines that may be used to treat severe diarrhea that does not improve with home treatment include:

  • Antidiarrheals, including diphenoxylate (such as Lomotil) and loperamide (such as Imodium), which slow intestinal movements.
  • Bile acid binding agents, including cholestyramine (such as Questran), which prevent bile acids from stimulating the colon, slowing the passage of stools and relieving diarrhea.
  • Alosetron (Lotronex), which is used for some women who have severe diarrhea and who have not responded to other treatments. This medicine slows the movement of stools through the bowels.

For constipation

There are many medicines for severe constipation that does not improve with home treatment. Most of these medicines are available without a prescription and are okay to take once in awhile. Check with your doctor before you use any of these medicines every day for constipation. Medicines for constipation include:

  • Lubiprostone (Amitiza), which works by increasing the amount of fluid in your intestines, making it easier for stool to pass.
  • Osmotic laxatives (such as Milk of Magnesia and nonabsorbable sugars such as lactulose), which work by holding fluids in the intestine and drawing fluids into the intestine from other tissue and blood vessels. This extra fluid in the intestines makes the stool softer and easier to pass.
  • Polyethylene glycol (such as MiraLax), which helps the stool hold on to more water, making it softer and easier to pass.
  • Stimulant laxatives (such as Senokot), which speed up how fast stool moves through the intestines by irritating the lining of the intestines.

For pain and cramping

The following medicines may be used for long-term pain and cramping:

  • Anticholinergics (antispasmodics), including dicyclomine (Bentyl), which help prevent or relieve painful cramping spasms in the intestines
  • Antidepressants, including desipramine (such as Norpramin), which in low doses can help with pain caused by IBS

For anxiety or depression

The following medicines may be used if your IBS causes you to have anxiety or depression:

  • Antidepressants, including fluoxetine (such as Prozac), which are especially helpful if you have depression and IBS
  • Antianxiety agents, including diazepam (such as Valium), which can be used short-term to help with anxiety if it makes your IBS symptoms worse

What To Think About

Few medicines have proven consistently helpful and all medicines have side effects, so medicine should be used for specific symptoms that disrupt your normal daily activities.

If you also have another illness, such as depression, that triggers symptoms of irritable bowel syndrome, medicine for that illness may be needed.

Alosetron, a medicine that decreases abdominal sensitivity, has been shown to relieve symptoms in some women who have severe diarrhea and who have not responded to other treatments. Although this medicine was previously removed from the market when its use was shown to contribute to ischemic bowel disease (which occurs when there is not enough blood flowing to the intestines), the U.S. Food and Drug Administration (FDA) reapproved alosetron for limited use in IBS. Specific guidelines for the use of alosetron require health professionals prescribing it to sign a certificate and patients to sign a consent form.

Surgery

Surgery is not done for irritable bowel syndrome (IBS).

Other Treatment

A wide range of other therapies has been used to treat irritable bowel syndrome (IBS). Treatment methods that help you better cope with stress can help reduce symptoms.

Other Treatment Choices

Fiber

Increasing the amount of fiber in your diet can help with some symptoms of IBS, especially constipation. You can get more fiber in your diet by eating foods that are high in fiber such as fresh fruits (raspberries, pears, apples), fresh vegetables (peas, spinach, celery), wheat bran, and whole-grain breads and cereals.

If you have trouble getting enough fiber in your diet, try a fiber supplement. Examples include psyllium (such as Metamucil). If you take a fiber supplement, start with a small dose and very slowly increase the dose over a month or more. Also, make sure you drink plenty of fluids, enough so that your urine is light yellow or clear like water.

Psychological treatment

Some kinds of psychological treatment may help with IBS symptoms. These treatments include cognitive-behavioral therapy, psychotherapy, and hypnosis.2

These treatment methods are usually more effective if they are used along with other treatment methods, such as diet changes, stress reduction, and sometimes medicine.

Other psychological treatments that are sometimes used for IBS include relaxation therapy, meditation, and biofeedback.

Complementary treatment

Because IBS is so different for each person and because no medicines have been proven to work really well for IBS, many people try alternative or complementary treatments. Some of these treatments have been studied and some have not. The evidence to support their use varies as much as the evidence seen when medicines for IBS are studied.

  • Herbal therapies, including Ayurvedic medicine and Chinese herbal medicine, may improve the symptoms of IBS. This has been shown in many studies of herbal therapy for IBS.6
  • Acupuncture is used as a treatment for IBS. But the effectiveness of acupuncture in treating IBS is still unknown.5
  • Peppermint oil has also been used to treat IBS. Studies have shown that peppermint oil works to improve IBS symptoms by preventing cramps and spasms in the intestines.2
  • Aloe is commonly used for IBS, especially IBS with constipation. There is currently no evidence for the use of aloe as an effective treatment for IBS.
  • Ginger has been used to treat nausea and has been studied as a treatment for nausea caused by seasickness and surgery. It is not known how well ginger helps in IBS.
  • Helpful bacteria, called probiotics, may help with IBS symptoms. Studies show that a supplement with a combination of types (called strains) of bacteria probably helps more than just one type. But more research is needed.2

Antibiotics

Experts are studying whether antibiotics may relieve symptoms of IBS. One antibiotic in particular, rifaximin (Xifaxan), has been shown to help IBS symptoms, especially bloating and diarrhea.2

What To Think About

Some people have been successful at handling stressful situations and controlling their symptoms after trying psychological therapies. These techniques are not harmful and have no side effects. Some of them can be used before a stressful event to prevent or reduce symptoms.

Other Places To Get Help

Organizations

American College of Gastroenterology
P.O. Box 342260
Bethesda, MD  20827-2260
Phone: (301) 263-9000
Web Address: www.acg.gi.org
 

The American College of Gastroenterology is an organization of digestive disease specialists. The Web site contains information about common gastrointestinal problems.


American Gastroenterological Association
4930 Del Ray Avenue
Bethesda, MD  20814
Phone: (301) 654-2055
Fax: (301) 654-5920
Web Address: www.gastro.org
 

The American Gastroenterological Association is a society of doctors who specialize in the digestive system (gastroenterologists). This Web site can help you find a gastroenterologist in your area. They also have patient information on many gastrointestinal diseases and disorders.


International Foundation for Functional Gastrointestinal Disorders
P.O. Box 170864
Milwaukee, WI  53217-8076
Phone: 1-888-964-2001
(414) 964-1799
Fax: (414) 964-7176
Email: iffgd@iffgd.org
Web Address: www.iffgd.org
 

The International Foundation for Functional Gastrointestinal Disorders (IFFGD) is a nonprofit organization that provides information and support to adults and children affected by hard-to-diagnose gastrointestinal (GI) disorders. The Web site has information about GI symptoms and conditions such as irritable bowel syndrome, indigestion, gastroesophageal reflux disease (GERD), incontinence, gas, bloating, belching, heartburn, nausea, and belly pain.


National Center for Complementary and Alternative Medicine (NCCAM) Clearinghouse
P.O. Box 7923
Gaithersburg, MD  20898
Phone: 1-888-644-6226
(301) 519-3153 for international calls
Fax: 1-866-464-3616 toll-free
TDD: 1-866-464-3615 toll-free
Email: info@nccam.nih.gov
Web Address: www.nccam.nih.gov/health/clearinghouse (or www.nccaminfo.org/livehelp/ for live help online)
 

The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) explores complementary and alternative healing practices in the context of rigorous science, trains complementary and alternative medicine researchers, and gives out authoritative information. Send all requests for information and questions about NCCAM to the NCCAM Clearinghouse.


National Digestive Diseases Information Clearinghouse (NDDIC)
2 Information Way
Bethesda, MD  20892-3570
Phone: 1-800-891-5389
Fax: (703) 738-4929
Email: nddic@info.niddk.nih.gov
Web Address: www.digestive.niddk.nih.gov
 

This clearinghouse is a service of the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the U.S. National Institutes of Health. The clearinghouse answers questions; develops, reviews, and sends out publications; and coordinates information resources about digestive diseases. Publications produced by the clearinghouse are reviewed carefully for scientific accuracy, content, and readability.


References

Citations

  1. Tack J (2006). Irritable bowel syndrome. In MM Wolfe et al., eds., Therapy of Digestive Disorders, 2nd ed., pp. 701–710. Philadelphia: Saunders Elsevier.
  2. American College of Gastroenterology (2009). An evidence-based systematic review on the management of irritable bowel syndrome. American Journal of Gastroenterology, 104(Suppl 1): S8–S35.
  3. American College of Gastroenterology (2009). An evidence-based position statement on the management of irritable bowel syndrome. American Journal of Gastroenterology, 104(Suppl 1): S1–S7.
  4. Talley NJ (2008). Functional gastrointestinal disorders: Irritable bowel syndrome, dyspepsia, and noncardiac chest pain. In L Goldman, D Ausiello, eds., Cecil Medicine, 23rd ed., pp. 990–998. Philadelphia: Saunders Elsevier.
  5. Lim B, et al. (2006). Acupuncture for treatment of irritable bowel syndrome. Cochrane Database of Systematic Reviews (4). Oxford: Update Software.
  6. Liu JP, et al. (2006). Herbal medicines for treatment of irritable bowel syndrome. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.
  7. Longstreth GF, et al. (2006). Irritable bowel syndrome section of Functional bowel disorders. In DA Drossman et al., eds., Rome III: The Functional Gastrointestinal Disorders, 3rd ed., pp. 490–509. McLean, VA: Degnon Associates.

Other Works Consulted

  • Chang I, et al. (2005). A dose-ranging, phase II study of the efficacy and safety of alosetron in men with diarrhea-predominant IBS. American Journal of Gastroenterology, 100(1): 115–123.
  • Ford AC, et al. (2008). Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: Systematic review and meta-analysis. BMJ. Published online November 13, 2008 (doi:10.1136/bmj.a2313).
  • Spanier JA, et al., (2003). A systematic review of alternative therapies in the irritable bowel syndrome. Archives of Internal Medicine, 163: 265–274.
  • Talley NJ (2006). Irritable bowel syndrome. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 2, pp. 2633–2652. Philadelphia: Saunders Elsevier.

Credits

By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology
Last Revised May 17, 2010

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