Diagnosis and management of irritable bowel syndrome

A practical overview for primary care providers

Authors

  • Howard Guo, MD Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary
  • Christian Turbide, MD Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary

DOI:

https://doi.org/10.58931/cpct.2023.1214

Abstract

Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) disorder estimated to affect 10% of the Canadian population. Despite its high prevalence, IBS remains a challenging condition to diagnose and manage due to its varied clinical presentations. Patients with IBS often experience a range of distressing symptoms, including abdominal pain, bloating, disordered bowel habits and psychological distress, which significantly impact their quality of life (QOL). As a result, patients with IBS are more likely to be high-frequency medical consulters, leading to an increased burden on healthcare systems. This article aims to provide a practical overview of IBS, including its diagnostic criteria, workup and management strategies.

Author Biographies

Howard Guo, MD, Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary

Dr. Howard Guo is a gastroenterology fellow at the University of Calgary. He earned his medical degree from the University of Ottawa and subsequently completed his residency in internal medicine at the University of Calgary. Alongside clinical care, he also has a strong interest in medical education, and has been actively involved in gastroenterology clinical teaching and medical education projects at the University of Calgary.

Christian Turbide, MD, Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary

Dr. Christian Turbide graduated from McGill University in gastroenterology with specialty training in therapeutic endoscopy and endoscopic retrograde cholangiopancreatography (ERCP). He completed his fellowship in endoscopic ultrasound. Dr. Turbide has been an examiner at the Royal College of Physicians and Surgeons for internal medicine and gastroenterology and is the past recipient of the endoscopy teacher of the year and clinic educator of the year. He is also the past President of the Alberta Society of Gastroenterology.

References

Sperber AD, Bangdiwala SI, Drossman DA, Ghoshal UC, Simren M, Tack J, Whitehead WE, Dumitrascu DL, Fang X, Fukudo S, Kellow J. Worldwide prevalence and burden of functional gastrointestinal disorders, results of Rome Foundation Global Study. Gastroenterology. 2021 Jan 1;160(1):99-114. doi:10.1053/j.gastro.2020.04.014 DOI: https://doi.org/10.1053/j.gastro.2020.04.014

Mearin F, Lacy BE, Chang L, et al. Bowel Disorders [published online ahead of print, 2016 Feb 18]. Gastroenterology. 2016;S0016-5085(16)00222-5. doi:10.1053/j.gastro.2016.02.031 DOI: https://doi.org/10.1053/j.gastro.2016.02.031

Farmer AD, Wood E, Ruffle JK. An approach to the care of patients with irritable bowel syndrome. CMAJ. 2020 Mar 16;192(11):E275-82. doi:10.1503/cmaj.190716 DOI: https://doi.org/10.1503/cmaj.190716

Canavan C, West J, Card T. The epidemiology of irritable bowel syndrome. Clin Epidemiol. 2014 Jan 4;6:71-80. doi:10.2147/CLEP.S40245 DOI: https://doi.org/10.2147/CLEP.S40245

Drossman DA, Morris CB, Schneck S, et al. International survey of patients with IBS: symptom features and their severity, health status, treatments, and risk taking to achieve clinical benefit. J Clin Gastroenterol. 2009;43(6):541-550. doi:10.1097/MCG.0b013e318189a7f9 DOI: https://doi.org/10.1097/MCG.0b013e318189a7f9

Camilleri M. Diagnosis and Treatment of Irritable Bowel Syndrome: A Review [published correction appears in JAMA. 2021 Apr 20;325(15):1568]. JAMA. 2021;325(9):865-877. doi:10.1001/jama.2020.22532 DOI: https://doi.org/10.1001/jama.2020.22532

Oka P, Parr H, Barberio B, Black CJ, Savarino EV, Ford AC. Global prevalence of irritable bowel syndrome according to Rome III or IV criteria: a systematic review and meta-analysis [published correction appears in Lancet Gastroenterol Hepatol. 2020 Dec;5(12):e8]. Lancet Gastroenterol Hepatol. 2020;5(10):908-917. doi:10.1016/S2468-1253(20)30217-X DOI: https://doi.org/10.1016/S2468-1253(20)30217-X

Moayyedi P, Andrews CN, MacQueen G, Korownyk C, Marsiglio M, Graff L, Kvern B, Lazarescu A, Liu L, Paterson WG, Sidani S. Canadian Association of Gastroenterology clinical practice guideline for the management of irritable bowel syndrome (IBS). J Can Assoc Gastroenterol. 2019 Feb 11;2(1):6-29. doi:10.1093/jcag/gwy071 DOI: https://doi.org/10.1093/jcag/gwy071

Böhn L, Störsrud S, Liljebo T, Collin L, Lindfors P, Törnblom H, Simrén M. Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial. Gastroenterology. 2015 Nov 1;149(6):1399-407. doi:10.1053/j.gastro.2015.07.054 DOI: https://doi.org/10.1053/j.gastro.2015.07.054

Dionne J, Ford AC, Yuan Y, Chey WD, Lacy BE, Saito YA, Quigley EM, Moayyedi P. A systematic review and meta-analysis evaluating the efficacy of a gluten-free diet and a low FODMAPs diet in treating symptoms of irritable bowel syndrome. Am J Gastroenterol. 2018 Sep 1;113(9):1290-300. doi:10.1038/s41395-018-0195-4 DOI: https://doi.org/10.1038/s41395-018-0195-4

McIntosh K, Reed DE, Schneider T, Dang F, Keshteli AH, De Palma G, Madsen K, Bercik P, Vanner S. FODMAPs alter symptoms and the metabolome of patients with IBS: a randomised controlled trial. Gut. 2017 Jul 1;66(7):1241-51. doi:10.1136/gutjnl-2015-311339 DOI: https://doi.org/10.1136/gutjnl-2015-311339

Staudacher HM, Lomer MC, Anderson JL, Barrett JS, Muir JG, Irving PM, Whelan K. Fermentable carbohydrate restriction reduces luminal bifidobacteria and gastrointestinal symptoms in patients with irritable bowel syndrome. J Nutr. 2012 Aug 1;142(8):1510-8. doi:10.3945/jn.112.159285 DOI: https://doi.org/10.3945/jn.112.159285

Ford AC, Harris LA, Lacy BE, Quigley EM, Moayyedi P. Systematic review with meta‐analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome. Aliment Pharmacol Ther. 2018 Nov;48(10):1044-60. doi:10.1111/apt.15001 DOI: https://doi.org/10.1111/apt.15001

Chey WD, Lembo AJ, Rosenbaum DP. Efficacy of tenapanor in treating patients with irritable bowel syndrome with constipation: a 12-week, placebo-controlled phase 3 trial (T3MPO-1). Am J Gastroenterol. 2020 Feb;115(2):281. doi:10.14309/ajg.0000000000001056 DOI: https://doi.org/10.14309/ajg.0000000000000516

Ross R, Chaput JP, Giangregorio LM, Janssen I, Saunders TJ, Kho ME, Poitras VJ, Tomasone JR, El-Kotob R, McLaughlin EC, Duggan M. Canadian 24-Hour Movement Guidelines for Adults aged 18–64 years and Adults aged 65 years or older: an integration of physical activity, sedentary behaviour, and sleep. Appl Physiol Nutr Metab. 2020;45(10):S57-102. doi:10.1139/apnm-2020-0467 DOI: https://doi.org/10.1139/apnm-2020-0467

Published

2023-06-14 — Updated on 2023-07-04

Versions

How to Cite

1.
Guo H, Turbide C. Diagnosis and management of irritable bowel syndrome: A practical overview for primary care providers. Can Prim Care Today [Internet]. 2023 Jul. 4 [cited 2024 May 16];1(2):18–22. Available from: https://canadianprimarycaretoday.com/article/view/1-2-guo_et_al

Issue

Section

Articles