Irritable Bowel Syndrome: Learning to Live with It

Irritable bowel syndrome (IBS) is a functional digestive disorder defined by chronic abdominal pain associated with bowel habit disturbances (diarrhea, constipation, or alternation of both).

Diagnosis

IBS is a diagnosis of exclusion based on Rome IV criteria:

• Recurrent abdominal pain at least 1 day/week on average over the last 3 months
• Associated with at least 2 of the following criteria: related to defecation, change in stool frequency, change in stool consistency

Therapeutic Approaches

Low FODMAP Diet

FODMAPs are fermentable sugars that worsen symptoms in 75% of IBS patients. The diet proceeds in 3 phases:

1. Elimination (4-6 weeks): removal of high-FODMAP foods
2. Reintroduction (6-8 weeks): individual testing of each group
3. Personalization: long-term adapted diet

Mind-body approaches

• Digestive hypnosis: efficacy demonstrated in several randomized trials
• CBT (cognitive-behavioral therapy)
• Yoga and mindfulness meditation

Symptomatic medications

• Antispasmodics for pain
• Osmotic laxatives or loperamide depending on transit profile
• Selected probiotics (strain-specific)

IBS is not "all in your head." It's a gut-brain axis disorder with identified neurophysiological bases.