Patient’s Guide to IBS – The Latest Insights from Leading Gastroenterologists

Irritable bowel syndrome (IBS) is one of the most common, yet often misunderstood, functional gastrointestinal disorders. Its symptoms can range from mild to disabling and frequently lead to a significant reduction in the quality of life for those affected. In an effort to provide the best possible knowledge and practical guidance for diagnosis and treatment, a large team of leading Indian gastroenterologists, researchers, and clinicians collaborated to create one of the most up-to-date and detailed consensus statements on the subject.

This article is entirely based on the publication titled “Indian consensus statements on irritable bowel syndrome in adults: A guideline by the Indian Neurogastroenterology and Motility Association and jointly supported by the Indian Society of Gastroenterology”, published in 2023 in the Indian Journal of Gastroenterology (42(2):249–273), with lead author Prof. Uday C. Ghoshal from Sanjay Gandhi Postgraduate Institute of Medical Sciences (Lucknow), along with co-authors from top medical institutions across India. The document presents the findings of an expert consensus reached after a detailed review of available evidence and clinical experience, involving 18 gastroenterologists and researchers with longstanding expertise in functional bowel disorders.

In the following sections, you’ll find answers to five key questions frequently asked by IBS patients. Every piece of information is taken directly from the cited scientific source.

“IBS is not a disease of the imagination—it's a real and modern medical condition with many faces and many solutions. Knowledge and support are the first steps toward a better life.”

Expert Insights

IBS is a common condition that significantly impacts quality of life, leads to missed workdays, reduces productivity, and creates an economic burden on society. In recent years, our understanding of the pathophysiology, diagnosis, and treatment of IBS has evolved rapidly. Patients and their loved ones are often faced with varying opinions and treatment options, which can create confusion and anxiety. This makes it essential to rely on expert consensus and scientific research that synthesize the best and most current knowledge on the condition.

In the five expert opinions below, you'll find key takeaways from the latest consensus developed by leading Indian gastroenterologists and researchers. These insights are not only relevant to India but also apply to patients worldwide, including in the United States. The goal is to help guide patients and their families toward the most effective diagnostic and therapeutic choices.

1. How Common Is IBS and Who Is Most Affected?

“IBS is a common condition in clinical practice and the Indian community... the prevalence of IBS in the Indian community varies from 0.4% to 4.2%.” “IBS is as prevalent in the male as the female population in India.”

Explanation: IBS is very common, although prevalence varies across countries and even regions. Unlike in Western countries, where women are more frequently affected, in India (and other countries with similar lifestyles), the condition occurs at similar rates among men and women. It's important for patients to understand that IBS can affect anyone, regardless of age, gender, or social status.

2. What Causes IBS? Its Multi-Dimensional Nature

“Etiopathogenesis of IBS is multi-dimensional including gut-specific mechanisms, altered gut-brain interaction, food intolerance, psychosocial and genetic factors.”

Explanation: IBS is not caused by a single factor. Mechanisms involved include altered gut motility, low-grade inflammation, imbalances in the gut microbiota (dysbiosis), food intolerances (e.g., lactose or FODMAPs), psychosocial stress, and even genetic predispositions. This complexity means that treatment needs to be personalized and holistic.

3. Is IBS Linked to Other Conditions or Past Infections?

“Gastrointestinal infection with varied pathogens may result in post-infection IBS (PI-IBS).” “COVID-19 may lead to post-COVID-19 IBS.”

Explanation: After gastrointestinal infections (caused by viruses, bacteria, or parasites), some individuals develop what is known as post-infectious IBS. There is also growing evidence that COVID-19 can increase the risk of developing IBS or similar functional gut issues. Patients who continue to experience digestive symptoms after recovering from an infection should talk to their doctor about the possibility of post-infectious IBS.

4. How Is IBS Diagnosed? Are Extensive Tests Needed?

“Diagnosis of IBS is primarily clinical and based on well-defined symptom-based criteria.” “In the absence of alarm features, a few baseline investigations are suggested for patients with suspected IBS.”

Explanation: IBS is primarily diagnosed based on symptoms (e.g., abdominal pain, changes in bowel habits), not through specific lab or imaging tests. In most cases, if there are no "alarm features" (such as anemia, bleeding, unexplained weight loss, or new symptoms in individuals over 45–50 years of age), extensive testing is not necessary. This helps prevent unnecessary procedures and anxiety.

5. What Is the Modern Approach to Treating IBS? Personalized and Multi-Layered Care

“Counseling, reassurance and lifestyle modification are important in the management of IBS.” “The initial treatment of IBS is primarily symptom based.”

Explanation: Lifestyle changes, regular physical activity, balanced nutrition (e.g., reducing FODMAPs when necessary), psychological support, and stress reduction are key. Treatment should target the most troubling symptoms: pain may respond to antispasmodics, constipation to fiber or laxatives, and diarrhea to anti-diarrheal medications. Some patients benefit from probiotics, although more research is needed. In more severe or resistant cases, specialized therapies, including psychotherapy, may be required.

FAQs

1. Can IBS Coexist with Other Gastrointestinal Conditions? Yes, very often!

“IBS patients in India often have other overlapping FGIDs... the overlaps between various FGIDs are common rather than exceptions... In an epidemiological study from northern India, of 2774 subjects 413 (14.9%) had dyspepsia alone, 75 (2.7%) IBS alone and 115 (4.1%) had dyspepsia-IBS overlap...”

Explanation: If you have IBS, there's a higher chance you may also have other functional GI disorders (like dyspepsia), which can include symptoms such as upper abdominal pain, nausea, or bloating. These “overlap” conditions may complicate symptoms and require tailored treatment approaches.

2. Is There a Link Between Gut Microbiota Imbalance (Dysbiosis) or Bacterial Overgrowth (SIBO) and IBS? Yes—especially in the diarrhea-predominant type!

“Patients with IBS, particularly those with diarrhea-predominant IBS (IBS-D), are more likely to have SIBO and gut dysbiosis... a recent meta-analysis, which included at least four Indian studies, showed that 36.7% of IBS patients had a positive test for SIBO...”

Explanation: Many people with IBS, especially those with diarrhea, show signs of microbial imbalance or even small intestinal bacterial overgrowth (SIBO). These factors may help explain symptoms and influence the choice of treatment.

3. What Role Do Psychological Factors and Stress Play in IBS?

“Psychological and somatoform comorbidities are common in IBS... pooled odds ratios of anxiety and depression were 8.060 (95% CI 4.007–16.213) and 7.049 (95% CI 3.281–15.147) compared to controls...”

Explanation: If you have IBS, you're more likely to also experience anxiety or depression compared to those without IBS. This doesn't mean your symptoms are “just in your head,” but rather that psychological health plays a significant role in the severity and persistence of IBS symptoms. A combined medical and psychological treatment plan often provides the best results.

4. Is There a Risk That IBS Could Be Mistaken for Another Condition? How Are Other Diseases Ruled Out?

“Diagnosis of IBS is primarily clinical and based on well-defined symptom-based criteria... the need for investigation only when otherwise indicated... In the presence of alarm features... thorough investigations to rule out organic disease are essential.”

Explanation: While IBS is typically diagnosed through symptom patterns, doctors must rule out other conditions like inflammatory bowel disease, celiac disease, infections, or cancer when alarm symptoms or atypical presentations are present. Most patients without such red flags don’t need extensive testing.

5. Can IBS Treatment Be the Same for Everyone?

“The multi-dimensional clinical profile of IBS needs to be incorporated into clinical practice as proposed in the Rome IV algorithm... Multi-dimensional clinical profile (MDCP) is a step toward understanding the multiple factors contributing to symptom generation in patients with IBS...”

Explanation: IBS is different for every person. Modern treatment requires an individualized approach, taking into account IBS subtype, symptom severity, psychosocial factors, and physiological specifics. Some people respond best to dietary changes, others to probiotics, medications, or psychotherapy.

6. What Should I Expect from Treatment—Can I Be Completely Cured?

“The initial treatment of IBS is primarily symptom based... the goal of treatment of IBS is also to relieve patients’ symptoms and improve the quality of life (QOL).”

Explanation: IBS is a chronic condition—it isn’t cured with a single pill, but symptoms can be managed effectively, and quality of life can improve significantly. Many patients experience long periods without symptoms or only very mild ones when following a well-tailored treatment and lifestyle plan.

7. What Role Do Exercise, Sleep, and Psychosocial Support Play in IBS?

“Counseling, reassurance and lifestyle modification are important in the management of IBS... physical exercise, including yoga, is useful in the management of IBS... Sleep disorders, common in IBS patients, should be recognized and appropriately treated...”

Explanation: There is solid evidence that regular physical activity (including walking, yoga, and light sports), quality sleep, and emotional support (counseling, support groups, relaxation techniques) help reduce IBS symptoms. These components are essential parts of today’s treatment strategies.

Conclusion

Irritable bowel syndrome remains a complex and highly individualized condition, requiring a personalized approach to both diagnosis and treatment. The information in this article, drawn from summarized scientific evidence and the clinical expertise of top Indian specialists, highlights the importance of an informed patient and active doctor-patient collaboration in decision-making. The expert-based Q&A aims to provide a practical, easy-to-understand, and evidence-based foundation upon which patients and their loved ones can build confidence and peace of mind in their day-to-day management of IBS.

Source: Uday C. Ghoshal et al., Indian consensus statements on irritable bowel syndrome in adults, Indian Journal of Gastroenterology (March–April 2023) 42(2):249–273, https://doi.org/10.1007/s12664-022-01333-5