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Clinical manifestations and diagnosis of irritable bowel syndrome in adults

Author
Arnold Wald, MD
Section Editor
Nicholas J Talley, MD, PhD
Deputy Editor
Shilpa Grover, MD, MPH, AGAF

INTRODUCTION

Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract characterized by chronic abdominal pain and altered bowel habits. However, only a small percentage of those affected seek medical attention [1-5]. Approximately 40 percent of individuals who meet diagnostic criteria for IBS do not have a formal diagnosis [6]. IBS is associated with increased health care costs and is the second highest cause of work absenteeism [7,8]. In the United States, IBS accounts for 25 to 50 percent of all referrals to gastroenterologists [9]. This topic will review the clinical manifestations and diagnosis of IBS. The pathophysiology and management of IBS are discussed in detail separately. (See "Pathophysiology of irritable bowel syndrome" and "Treatment of irritable bowel syndrome in adults".)

EPIDEMIOLOGY

Prevalence — The prevalence of irritable bowel syndrome (IBS) in North America estimated from population-based studies is approximately 10 to 15 percent [1,2,10-14]. In a meta-analysis that included eight international studies, the pooled prevalence of IBS was estimated to be 11 percent, with wide variation by geographic region [15]. The prevalence of IBS was 25 percent lower in those aged over 50 years as compared with those who were younger (OR, 0.75; 95% CI, 0.62-0.92) [14]. The overall prevalence of IBS in women was higher as compared with men (odds ratio 1.67 [95% CI 1.53–1.82]) [16]. This relative difference reflects an absolute difference in prevalence of approximately 5 percent between the sexes, with a prevalence in women and men of 14 and 9 percent, respectively. Women may be more likely to have constipation-predominant IBS as compared with men [16].

Associated conditions — IBS is associated with other conditions including fibromyalgia, chronic fatigue syndrome (also known as systemic exertion intolerance disease), gastroesophageal reflux disease, functional dyspepsia, non-cardiac chest pain, and psychiatric disorders including major depression, anxiety, and somatization [17-21]. (See "Pathophysiology of irritable bowel syndrome", section on 'Psychosocial dysfunction'.)

CLINICAL MANIFESTATIONS

Irritable bowel syndrome (IBS) is characterized by chronic abdominal pain and altered bowel habits [17].

Chronic abdominal pain — Abdominal pain in IBS is usually described as a cramping sensation with variable intensity and periodic exacerbations. The location and character of the pain can vary widely [17,22]. The severity of the pain may range from mild to severe. The pain is frequently related to defecation. While in some patients abdominal pain is relieved with defecation, some patients report worsening of pain with defecation [23]. Emotional stress and meals may exacerbate the pain. Patients with IBS also frequently report abdominal bloating and increased gas production in the form of flatulence or belching.

               

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Literature review current through: Aug 2017. | This topic last updated: Sep 11, 2017.
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