Irritable bowel syndrome

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