Irritable bowel syndrome


  • N. J. Talley

    Corresponding author
    1. Mayo Clinic College of Medicine, Dyspepsia Center, Clinical Enteric Neuroscience Translational and Epidemiological Research Program, Rochester, Minnesota, USA and Department of Medicine, University of Sydney, Nepean Hospital, Sydney, New South Wales, Australia
    • Dr Nicholas J. Talley, Mayo Clinic, 200 First Street S.W., PL-6-56, Rochester, MN 55905, USA.

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  • Funding: This work was supported in part by NIH grant U01DK 65713-1 to Dr Talley.

    Potential conflicts of interest: Consultant or research support: Novartis, Solvay, Axcan, Bohringer-Ingelheim, Giaconda and GlaxoSmithKline.


Conceptually, the irritable bowel syndrome (IBS) has been considered a brain-gut functional disorder, but this paradigm is under serious challenge. There is increasing evidence that organic disease of the gastrointestinal tract can be identified in subsets of patients who fulfil the Rome criteria for IBS. Evidence for subtle inflammatory bowel disease, serotonin dysregulation, bacterial overgrowth and central dysregulation continue to accumulate. The underlying causes of IBS remain to be adequately identified, but postinfectious IBS is a clear-cut entity. Furthermore, a genetic contribution to IBS also seems likely. Diagnosis continues to be based on the symptom profile and the absence of alarm features. A heightened awareness of coeliac disease masquerading as IBS is becoming accepted. Management remains largely based on symptomatic rather than on disease-modifying therapy, but this is likely to change in the near future. Here, recent advances in the pathophysiology and management of IBS are considered.