An evidence-based update on the diagnosis and management of irritable bowel syndrome

Black, Christopher J.; Ford, Alexander C.

doi:10.1080/17474124.2025.2455586

Cited by 27Gastrointestinal motility and disordersInfant Health and DevelopmentGut microbiota and health

An evidence-based update on the diagnosis and management of irritable bowel syndrome

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Black, Christopher J., Ford, Alexander C.·2025·Expert Review of Gastroenterology & Hepatology

DOI 10.1080/17474124.2025.2455586

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Abstract

INTRODUCTION: Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction affecting 5% of the population. The cardinal symptoms are abdominal pain and altered stool form or frequency. AREAS COVERED: Diagnosis and management of IBS. We searched the literature for diagnostic accuracy studies, randomized controlled trials, and meta-analyses. A positive diagnosis of IBS, alongside testing to exclude celiac disease, is recommended. Exhaustive investigation has a low yield. Patients should be offered traditional dietary advice. If response is incomplete, specialist dietetic guidance should be considered. Probiotics may be beneficial, but quality of evidence is poor. First-line treatment of constipation is with laxatives, with secretagogues used where these are ineffective. Anti-diarrheal drugs should be used first-line for diarrhea, with second-line drugs including 5-hydroxytryptamine-3 antagonists, eluxadoline, or rifaximin, where available. First-line treatment of abdominal pain should be with antispasmodics, with gut-brain neuromodulators prescribed second-line. Low-dose tricyclic antidepressants, such as amitriptyline, are preferred. Brain-gut behavioral therapies are effective and have evidence for efficacy in patients refractory to standard therapies. EXPERT OPINION: Despite substantial advances, there remains scope for improvement in terms of both the diagnosis and management of IBS. Reinforcement of positive diagnostic strategies for the condition and novel treatment paradigms are required.

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Other medications-including antispasmodics (e.g., dicyclomine and pinaverium), antibiotics such as rifaximin, and guanylate cyclase-C agonists such as linaclotide-are sometimes used to manage NPP-related comorbid symptoms but do not directly alleviate pain.
“Additionally, other medications—including antispasmodics (e.g., dicyclomine and pinaverium), antibiotics such as rifaximin, and guanylate cyclase-C agonists such as linaclotide—are sometimes used to manage NPP-related comorbid symptoms but do not directly alleviate pain (187).”
From Nociplastic pain: the prominent role of non-neuronal cells in central and peripheral sensitization (2026) · cites this paper as [187]

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(2016) · PubMed · Cited by 17 · see citing works
Advances in diagnosis and management of irritable bowel syndrome
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Authors: Black, C. J., & Ford, A. C.
Affiliations: University of Leeds (GB)
Corresponding author: Ford, Alexander C.
ORCID: Black, Christopher J.
Ford, Alexander C.
Venue: Expert Review of Gastroenterology & Hepatology
Publisher: Informa UK Limited
Published: 2025-01-21
Volume: 19
Issue: 3
Pages: 227-242
ISSN: 1747-4124 (ISSN-L)
1747-4132
DOI: 10.1080/17474124.2025.2455586
OpenAlex: W4406674671
Cited by: 27
References: 161
Citations by year: 2026: 22 · 2025: 5
FWCI: 6.45
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc-nd
creativecommons.org/licenses/by-nc-nd/4.0/ (vor)
Locations: Expert Review of Gastroenterology & Hepatology (publishedVersion, cc-by-nc-nd)
PubMed (publishedVersion)
White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
Topics: Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
Health Sciences › Health Professions › Pharmacy › Infant Health and Development
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
Keywords: irritable bowel syndrome, IBS diagnosis, IBS management, gut-brain axis, abdominal pain, constipation, diarrhea, probiotics, laxatives, secretagogues, antidiarrheal agents, serotonin antagonists, eluxadoline, rifaximin, antispasmodic agents, tricyclic antidepressants, amitriptyline, celiac disease exclusion

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An evidence-based update on the diagnosis and management of irritable bowel syndrome

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