Evidence-Based Answers to the Most Important Questions for IBS Patients

Irritable Bowel Syndrome (IBS) is a chronic functional disorder of the gastrointestinal (GI) tract that affects millions of people worldwide. It often disrupts daily life, social interactions, and psychological well-being. In response to the need for up-to-date, evidence-based recommendations, leading Korean gastroenterologists, psychologists, and public health experts—brought together by the Korean Society of Neurogastroenterology and Motility—developed consensus clinical guidelines for the diagnosis and treatment of IBS in 2025.

The information in this article is entirely based on the publication "2025 Seoul Consensus on Clinical Practice Guidelines for Irritable Bowel Syndrome," published in the Journal of Neurogastroenterology and Motility (Vol. 31, No. 2, April 2025). The author team includes 16 leading gastroenterologists, 2 psychologists, and specialists in evidence-based medicine from various universities and hospitals in South Korea, all with extensive experience in both clinical practice and IBS research.

The following questions and answers synthesize the most important practical aspects that IBS patients would want to know—presented in a clear, accessible way while maintaining scientific accuracy.

"Irritable Bowel Syndrome isn’t just a ‘fussy stomach’—it’s a complex interaction between the gut, brain, and mind, which can be managed through accurate diagnosis, a personalized approach, and informed awareness."

Expert Insights

Irritable Bowel Syndrome (IBS) is one of the most common functional gastrointestinal disorders, significantly affecting patients’ quality of life and social functioning. Due to its chronic nature, diverse symptoms, and complex causes, IBS often leads to confusion, anxiety, and difficulty making informed decisions about diagnosis and treatment. That’s why it's essential for patients and their loved ones to have access to current, reliable, and balanced information from leading medical experts and researchers.

Below are five expert opinions and direct quotes taken from the latest consensus clinical guidelines, developed by top gastroenterologists and scientists in the field. Each quote is accompanied by an explanatory question or title designed to help patients or their families find direction in seeking answers or support.

1. How is IBS diagnosed, and when is a colonoscopy necessary?

"Colonoscopy is recommended for patients with IBS who exhibit alarming features or those who have not undergone appropriate colon cancer screening. Routine colonoscopy is not recommended for all patients with IBS. Patients with new-onset IBS symptoms who have not undergone appropriate colon cancer screening are advised to undergo the procedure. Colonoscopy should be considered for patients with alarming symptoms such as hematochezia, nocturnal diarrhea, unexplained weight loss, iron deficiency anemia, or a family history of colorectal cancer or other GI malignancies. Colonoscopy is indicated in patients who do not respond to conventional IBS treatments."

Explanation: IBS is typically diagnosed based on characteristic symptoms and by ruling out other organic diseases. Colonoscopy is recommended only if so-called “alarming symptoms” are present—such as blood in the stool, nighttime diarrhea, unexplained weight loss, iron deficiency anemia, or a family history of colorectal cancer. It’s also advised for those over 50 or patients whose symptoms don’t improve with standard treatment.

2. What are the major risk factors for the development and severity of IBS?

"The onset and severity of IBS is influenced by genetic, environmental, psychological, and lifestyle factors. A comprehensive patient history should be obtained to identify potential risk factors such as previous GI infections, psychological stress, and a family history of IBS. Psychological health assessments including screening for depression and anxiety, which can exacerbate IBS symptoms, are important."

Explanation: IBS is considered to result from an interaction of genetics, environment, psychological state, and lifestyle. Prior GI infections, stress, anxiety, depression, and family history play a significant role. This means that evaluation and treatment often require a multidisciplinary approach, including psychological support.

3. What lab tests are needed and what do they show?

"Laboratory tests are useful for differentiating IBS from organic diseases in patients with alarming features. Erythrocyte sedimentation rate, C-reactive protein levels, and fecal calprotectin levels can be used to differentiate IBS-D from IBD. Routine testing for enteric pathogens and fecal occult blood is not recommended."

Explanation: Routine lab tests like C-reactive protein (CRP) and fecal calprotectin are used to rule out inflammatory bowel diseases (IBD) in cases of suspicion. Unnecessary testing for pathogens or hidden blood in stool is avoided in typical cases without alarming symptoms.

4. What non-pharmacological therapies are effective for IBS? (Diet and exercise)

"A low FODMAP diet is effective in improving the overall symptoms of IBS. A low FODMAP diet improves global IBS symptoms, bloating, and bowel habits. Additionally, it can improve patients’ quality of life. Since most studies have involved dieticians, their participation is encouraged. If dietitians are unavailable, high-quality teaching materials should be used."

"Appropriate exercise can help improve the overall symptoms of patients with IBS. Although there is limited evidence, appropriate instructions are needed for the type and intensity of exercise, and slow, low intensity exercise such as walking, yoga, and cycling is recommended over hard, strenuous exercise."

Explanation: A low FODMAP diet—low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols—has been shown to relieve IBS symptoms. Physical activity, especially light exercises like walking or yoga, is also beneficial. It’s best to consult a dietitian and introduce new habits gradually.

5. What’s the approach for therapy-resistant (refractory) IBS?

"Refractory IBS is defined as a case in which the patient’s symptoms are not relieved by conventional interventions, necessitating a more specialized, multidisciplinary approach. There is a lack of universally accepted and clear definitions for refractory IBS. Patients with refractory IBS require a multidisciplinary approach. Some studies define refractory IBS as symptoms persisting for 6 to 12 months without significant improvement."

Explanation: For patients whose symptoms persist without improvement after 6–12 months of standard therapies, a multidisciplinary approach is recommended—this might include a gastroenterologist, psychologist, dietitian, and other specialists as needed. Continuing ineffective treatments for too long should be avoided.

Questions & Answers

1. How common is IBS and who does it affect most? 

Answer: IBS is extremely common, affecting around 10–11% of people globally. It is more frequently seen in women and younger individuals but can affect both genders and all age groups. The condition can significantly lower quality of life, lead to missed work, and even social isolation, adding to the economic burden on patients and society.

2. What are the main symptoms of IBS and how is it diagnosed? 

Answer: IBS is characterized by recurring abdominal pain associated with changes in stool form or frequency. Diagnosis is typically made using the Rome IV criteria, which require the pain to occur at least once per week over the past 3 months, along with at least two of the following: a change in stool appearance, a change in frequency, or relief after bowel movement. IBS is also classified into subtypes based on predominant symptoms: constipation, diarrhea, mixed, or unclassified.

3. Why is treating IBS so challenging? 

Answer: The exact causes of IBS are still not fully understood. Contributing factors include abnormal gut motility, changes in gut microbiota, heightened gut sensitivity, hormonal and neurological factors, and psychological issues such as stress, anxiety, and depression. That’s why treatment is often “symptom-based,” targeting the most bothersome symptoms, which may not always be enough and can lead to patient dissatisfaction. A personalized and multidisciplinary care plan is essential.

4. How important is mental health in IBS? 

Answer: Mental health factors are highly significant—stress, anxiety, and depression can not only trigger but also worsen IBS symptoms. There is a bidirectional connection between the brain and the gut (the “gut-brain axis”), which explains how emotional states directly affect physical symptoms. For some people, psychological issues precede IBS, while for others, IBS itself can lead to depression or anxiety.

5. Are there different types of IBS, and what do they mean for treatment? 

Answer: Yes, IBS is divided into four main subtypes based on bowel habits: IBS-C (constipation-predominant), IBS-D (diarrhea-predominant), IBS-M (mixed type with alternating diarrhea and constipation), and IBS-U (unclassified). Identifying your subtype is crucial for selecting the most appropriate therapy—such as laxatives for IBS-C, anti-diarrheal agents for IBS-D, and other tailored approaches.

Conclusion 

Irritable Bowel Syndrome remains a complex and highly individual condition that requires a personalized approach grounded in the latest clinical guidelines and scientific evidence. Reliable, structured information—presented in plain language—empowers patients and their families to better understand the condition, the potential challenges, and the ways to manage it effectively in daily life.

This Q&A resource, entirely based on the 2025 consensus publication, is designed to support those living with IBS and to help facilitate more productive conversations between patients and healthcare providers. The right information is the first step toward a better quality of life—even with a chronic condition like IBS.

Source: 

Choi, Yonghoon, et al. "2025 Seoul Consensus on Clinical Practice Guidelines for Irritable Bowel Syndrome." Journal of Neurogastroenterology and Motility, Vol. 31, No. 2, April 2025, pp. 133–169. DOI: 10.5056/jnm25007