Bowel Habit Subtypes and Temporal Patterns in Irritable Bowel Syndrome: Systematic Review
Abstract
UNLABELLED: Irritable bowel syndrome (IBS) is a heterogeneous condition characterized by the presence of abdominal discomfort or pain and bowel habit alterations: constipation (C-IBS), diarrhea (D-IBS), or alternating C and D (A-IBS). Its clinical course is poorly known. OBJECTIVES: (i) To compare bowel habit subtypes distribution in IBS according to sample origin and diagnosis criteria; (ii) To evaluate IBS temporal patterns based on follow-up studies. METHODS: A literature search (1966-2003) was conducted in the MEDLINE and EMBASE databases. A total of 72 studies were found and 22 were finally selected. RESULTS: Population-based studies from the United States (Manning) found similar distribution among C-IBS, D-IBS, and A-IBS, while European studies (Rome I, Rome II, or self-reporting) showed either C-IBS or A-IBS as the most prevalent subtypes. Primary care office-based studies (Rome I or Rome II) showed A-IBS as the most prevalent group. Gastroenterology specialized office-based studies found either C-IBS or D-IBS as the most frequently reported subtype. Prospective follow-up investigations showed that the most frequent IBS temporal pattern profile consists of mild to moderate symptoms appearing in cluster in an intermittent way, about once a week, and lasting 2-5 days on average. CONCLUSION: IBS clinical subtypes distribution differs depending on the population evaluated, the geographical location, and the criteria employed to define IBS and bowel habit subtypes. In most cases, clinical course is characterized by the presence of mild-to-moderate symptoms appearing sequentially. Prospective studies, using clear and stable diagnostic criteria and subtype definitions, and based on daily data collection should further characterize IBS clinical course.
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The mean score of four weekly assessments of GSRS-IBS was used to get reliable estimates of participants' symptom levels at each assessment point because IBS symptoms vary considerably over time.
“Since IBS symptoms are known to vary considerably over time [44], the mean score of four weekly assessments of GSRS-IBS was used to get reliable estimates of the participants' symptom levels at each assessment point.”
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Subtypes of Irritable Bowel Syndrome in Children: Prevalence at Diagnosis and at Follow-Up
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“Most of the available studies reported A-IBS to be the most common subgroup,(26) especially when the investigation is primary care office based.(8) Ersryd and”
BackgroundResultSubtypes of Irritable Bowel Syndrome in Children and Adolescents
Self, M. M., Czyzewski, D. I., Chumpitazi, B. P., Weidler, E. M., & Shulman, R. J. (2014) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2014.01.031 · Cited by 49 · see citing works
Study design considerations for irritable bowel syndrome clinical trials.
Miller, L. E. (2014) · Europe PMC (PubMed Central) · Cited by 48 · see citing works
White, P. D. (2010) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2010.01.008 · Cited by 46 · see citing works
“Testing the heterogeneity of other FSSs is less well developed, but preliminary studies suggest that other FSSs may also be heterogeneous [24,25], as well as sharing commonalities [26].”
BackgroundProbiotics in Irritable Bowel Syndrome: A Review of Their Therapeutic Role
Kumar, L. S., Pugalenthi, L. S., Ahmad, M., Reddy, S., Barkhane, Z., & Elmadi, J. (2022) · Cureus · doi:10.7759/cureus.24240 · Cited by 52 · see citing works
“There are four major bowel patterns observed in IBS that are, namely, IBS-D (predominant diarrhea), IBS-C (predominant constipation), IBS-M (mixed diarrhea and constipation), and IBS-U (the unclassified type, symptoms of which cannot be categorized into any one of the three subtypes that have been mentioned) [28].”
BackgroundSanders, K. A., Blanchard, E. B., & Sykes, M. A. (2007) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-007-9037-7 · Cited by 43 · see citing works
The Role of Fiber in the Treatment of Irritable Bowel Syndrome
Zuckerman, M. J. (2005) · Journal of Clinical Gastroenterology · doi:10.1097/01.mcg.0000196405.15110.bb · Cited by 42 · see citing works
Irritable Bowel Syndrome and Small Intestinal Bacterial Overgrowth
Yamini, D., & Pimentel, M. (2010) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0b013e3181ef3476 · Cited by 41 · see citing works
“Although uncontrolled, this study was the beginning of the basis for a bacterial hypothesis in IBS.”
BackgroundInfluentialWang, Y. M., Chang, Y., Chang, Y.-E., Cheng, J.-J., Li, J., Wang, T., Zhang, Q. Y., Liang, D. C., Sun, B., & Wang, B. M. (2012) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2012.01902.x · Cited by 38 · see citing works
Rey, E., Mearin, F., Alcedo, J., Ciriza, C., Delgado-Aros, S., Freitas, T., Mascarenhas, M., Mínguez, M., Santos, J., & Serra, J. (2017) · Advances in Therapy · doi:10.1007/s12325-016-0473-8 · Cited by 37 · see citing works
“A significant proportion of IBS patients have symptomatic episodes for years that may need long-term treatment [29, 30].”
BackgroundSelf-citationRivkin, A. M., & Rybalov, S. (2016) · Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy · doi:10.1002/phar.1712 · Cited by 35 · see citing works
“Other organic causes of these symptoms need to be ruled out before the diagnosis of IBS is made.2 The three types of IBS are IBS diarrhea-predominant (IBS-D), IBS constipation-predominant (IBS-C), and IBS mixed-symptoms (IBS-M), which occur in approximately equal proportions of patients in the United States.3 Current…”
BackgroundBolino, C., & Berčík, P. (2010) · Infectious Disease Clinics of North America · doi:10.1016/j.idc.2010.07.005 · Cited by 34 · see citing works
Khalilian, A., Ahmadimoghaddam, D., Saki, S., Mohammadi, Y., & Mehrpooya, M. (2021) · BioPsychoSocial Medicine · doi:10.1186/s13030-021-00205-2 · Cited by 34 · see citing works
“Diarrhea-predominant IBS is a debilitating form of IBS which significantly reduces the quality of life of patients, increases health care expenditures, impairs social and occupational functioning, and increases psychological disorders [28].”
BackgroundLow FODMAPs and gluten-free foods for irritable bowel syndrome treatment: Lights and shadows
Zannini, E., & Arendt, E. K. (2017) · Food Research International · doi:10.1016/j.foodres.2017.04.001 · Cited by 33 · see citing works
Katsinelos, P., Lazaraki, G., Kountouras, J., Paroutoglou, G., Oikonomidou, I., Mimidis, K., Koutras, C., Gelas, G., Τζιόμαλος, Κ., Zavos, C., et al. (2009) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0b013e328312eb97 · Cited by 33 · see citing works
Mearin, F., Badia, X. C., Balboa, A., Benavent, J., CABALLERO, A. M., Domínguez‐Muñoz, J. E., Garrigues, V., Pique, J. M., Roset, M., Cucala, M., et al. (2006) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2006.02828.x · Cited by 31 · see citing works
Self-citationTriantafillidis, J. K., & Malgarinos, G. (2014) · Clinical and Experimental Gastroenterology · doi:10.2147/ceg.s46291 · Cited by 30 · see citing works
Impact of upper digestive symptoms in patients with irritable bowel syndrome
Mearin, F., Mearin, F. N., a, X. B., Benavent, J., Caballero, A. M., Domínguez‐Muñoz, J. E., Garrigues, V., Piqu, J. M. A., Roset, M., Cucala, M., et al. (2006) · European Journal of Gastroenterology & Hepatology · doi:10.1097/01.meg.0000243870.41207.2f · Cited by 26 · see citing works
Self-citationO’Malley, D. (2018) · Experimental Physiology · doi:10.1113/ep087443 · Cited by 25 · see citing works
Waqar, S. H. B., & Rehan, A. (2019) · Cureus · doi:10.7759/cureus.4764 · Cited by 23 · see citing works
de Medeiros, M. T. G., Carvalho, A. F., Lima, J. W. D. O., dos Santos, A. A., de Oliveira, R. B., & Souza, M. A. N. (2008) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e318183f896 · Cited by 22 · see citing works
“…present study, we aimed to test rectal hypersensitivity thresholds in different subtypes of IBS patients, because there are evidences in the literature for differences in pathophysiology according to bowel habits, including different disease courses and treatment responses (Guilera et al., 2005).”
BackgroundIrritable bowel syndrome in adolescents in Lagos
Adeniyi, O. F., Lesi, O. A., Olatona, F. A., Esezobor, C. I., & Ikobah, J. M. (2017) · Pan African Medical Journal · doi:10.11604/pamj.2017.28.93.11512 · Cited by 22 · see citing works
“Some reports have also noted that these subtypes may change with time in some children [21].”
BackgroundRecent developments in the therapy of irritable bowel syndrome
Saad, R. J., & Chey, W. D. (2008) · Expert Opinion on Investigational Drugs · doi:10.1517/13543784.17.2.117 · Cited by 21 · see citing works
“Most patients will experience intermittent mild-to-moderate symptoms that occur in clusters rather than randomly [1] .”
BackgroundMethodLin, S., Mooney, P. D., Kurien, M., Aziz, I., Leeds, J. S., & Sanders, D. S. (2014) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000000171 · Cited by 21 · see citing works
Inhibition of Phosphodiesterase Type 4 Decreases Stress-Induced Defecation in Rats and Mice
Barone, F. C., Barton, M. E., White, R. F., Legos, J. J., Kikkawa, H., Shimamura, M., Kuratani, K., & Kinoshita, M. (2007) · Pharmacology · doi:10.1159/000107662 · Cited by 21 · see citing works
Rosmalen, J. G. M. (2010) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2009.12.003 · Cited by 20 · see citing works
“For example, IBS is often split into constipation and diarrhea predominant [4], whereas factor analyses have defined subtypes of FM [5] and CFS [6].”
BackgroundCurrent and emerging drug options in the treatment of diarrhea predominant irritable bowel syndrome
Nee, J. W., Zakari, M., & Lembo, A. J. (2015) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.2015.1101449 · Cited by 19 · see citing works
“[4] Population-based studies indicate that IBS-D may represent approximately one-third of those diagnosed with IBS, though the prevalence may be higher in specialty practices.[5] The pathophysiology of IBS-D is multifactorial, involving a complex interplay among visceral hypersensitivity, genetics, environment, gut mi…”
BackgroundDo Children Just Grow Out of Irritable Bowel Syndrome?
Giannetti, E., Maglione, M., Sciorio, E., Coppola, V., Miele, E., & Staiano, A. (2017) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2016.12.036 · Cited by 18 · see citing works
Síndrome del intestino irritable: nuevos criterios de Roma III
Mearin, F. (2007) · Medicina Clínica · doi:10.1157/13099805 · Cited by 18 · see citing works
Self-citationGastrointestinal symptoms - an illness burden that affects daily work in patients with IBS
Faresjö, Å., Walter, S., Norlin, A., Faresjö, T., & Jones, M. P. (2019) · Health and Quality of Life Outcomes · doi:10.1186/s12955-019-1174-1 · Cited by 17 · see citing works
“IBS is subtyped according to the predominant symptoms into constipation (IBS-C), diarrhoea (IBS-D) mixed (IBS-M) and unspecified (IBS-U) [6].”
BackgroundIrritable Bowel Syndrome: More Than Abdominal Pain and Bowel Habit Abnormalities
Bond, B., Quinlan, J., Dukes, G. E., Mearin, F., Clouse, R. E., & Alpers, D. (2008) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2008.08.011 · Cited by 17 · see citing works
Self-citationRusu, F., & Dumitrascu, D. L. (2015) · Medicine and Pharmacy Reports · doi:10.15386/cjmed-449 · Cited by 16 · see citing works
“Currently, most studies on the prevalence of IBS are developed on the basis of questionnaires distributed to patients [10-12].”
BackgroundMulti-omics Analysis of Gut Microbiota and Metabolites in Rats With Irritable Bowel Syndrome
Liu, S., Si, C., Yu, Y., Zhao, G., Chen, L., Zhao, Y., Zhang, Z., Li, H., Chen, Y., Min, L., et al. (2019) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2019.00178 · Cited by 15 · see citing works
Ríos, C. C. D. L., Falcón, B. S., Argüelles‐Arias, F., Pérez, E., Teruel, C., Geijo, F., & Rey, E. (2021) · Therapeutic Advances in Gastroenterology · doi:10.1177/17562848211020570 · Cited by 15 · see citing works
Novel Therapies in IBS-D Treatment
Nee, J. W., Zakari, M., & Lembo, A. J. (2015) · Current Treatment Options in Gastroenterology · doi:10.1007/s11938-015-0068-5 · Cited by 15 · see citing works
Is irritable bowel syndrome associated with chronic hepatitis C?
Fouad, Y. M., Makhlouf, M. M., Khalaf, H., Mostafa, Z., Abdel-Raheem, E. M., & Meneasi, W. (2010) · Journal of Gastroenterology and Hepatology · doi:10.1111/j.1440-1746.2010.06311.x · Cited by 15 · see citing works
Serotonin transporter gene polymorphisms in irritable bowel syndrome
Geeraerts, B., Oudenhove, L. V., & Tack, J. F. (2006) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2006.00854.x · Cited by 15 · see citing works
Sámano, R., Esparza-Juárez, F., Chico‐Barba, G., González-Medina, E., Sánchez-Jiménez, B., & Hernández‐Trejo, M. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191710569 · Cited by 14 · see citing works
Lee, M. J. (2014) · International Journal of Gastroenterology Disorders & Therapy · doi:10.15344/2393-8498/2014/108 · Cited by 14 · see citing works
Penny, K. I., Smith, G. D., Ramsay, D., Steinke, D. T., Kinnear, M., & Penman, I. D. (2008) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2008.04.004 · Cited by 13 · see citing works
“Division into subgroups is widely used in research studies, but its usefulness in clinical practice is unclear and the relative proportion of patients in each subgroup varies across reported series (Guilera et al., 2005).”
BackgroundGuía de práctica clínica sobre el síndrome del intestino irritable
Tort, S., Balboa, A., Marzo‐Castillejo, M., Muñoz, R. C., Mínguez, M., Valdepérez, J., Alonso‐Coello, P., Mascort, J. J., Ferrándiz, J., Bonfill, X., et al. (2006) · Gastroenterología y Hepatología · doi:10.1157/13092567 · Cited by 15 · see citing works
Self-citationClavé, P. (2011) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2011.01808.x · Cited by 12 · see citing works
Quénéhervé, L., Drui, D., Blin, J., Péré, M., Coron, E., Barbara, G., Barbaro, M. R., Cariou, B., Neunlist, M., Masson, D., et al. (2021) · Scientific Reports · doi:10.1038/s41598-021-87158-2 · Cited by 11 · see citing works
He, Y., Xu, R., Wang, W., Zhang, J., & Hu, X. (2020) · Medicine · doi:10.1097/md.0000000000021502 · Cited by 11 · see citing works
Xia, X., Xie, Y., Chen, Q., Ding, D., Wang, Z., Xu, Y., Wang, Y., Wang, X., & Ding, W. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.1053103 · Cited by 11 · see citing works
Longstreth, G. F., & Tieu, R. S. (2015) · Digestive Diseases and Sciences · doi:10.1007/s10620-015-3892-5 · Cited by 11 · see citing works
“The chronic symptoms of IBS tend to occur intermittently for periods of about 2–5 days [25].”
BackgroundStaller, K. D., Goodoory, V. C., Khasawneh, M., Black, C. J., & Ford, A. C. (2026) · The Lancet. Gastroenterology & hepatology · doi:10.1016/s2468-1253(26)00118-4 · Cited by 11 · see citing works
Epidemiology of Irritable Bowel Syndrome in a Large Academic Safety-Net Hospital
Cheng, K., Lee, C., Garniene, R., Cabral, H., & Weber, H. C. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13051314 · Cited by 10 · see citing works
“Although a systematic review in 2005 reported an even distribution of IBS-C, IBS-D, and IBS-M subtypes among IBS patients in the US, there has not yet been a comprehensive study describing the distribution of IBS subtypes across different racial groups [26].”
BackgroundSong, Z., Kwon, T., Lee, J., Won, D. D., Lee, B. J., Choi, H. S., Liao, J. C., Park, W. G., Sonu, I. S., Rogalla, S., et al. (2025) · Advanced Science · doi:10.1002/advs.202503247 · Cited by 10 · see citing works
Irritable bowel syndrome: focus on otilonium bromide
Boeckxstaens, G. E., Clavé, P., Corazziari, E. S., & Tack, J. F. (2014) · Expert Review of Gastroenterology & Hepatology · doi:10.1586/17474124.2014.869477 · Cited by 10 · see citing works
Développer un médicament dans le syndrome de l’intestin irritable : une mission impossible ?
Duracinský, M., & Chassany, O. (2009) · Gastroentérologie Clinique et Biologique · doi:10.1016/s0399-8320(09)71522-2 · Cited by 10 · see citing works
New Criteria for Irritable Bowel Syndrome Based on Prospective Symptom Evaluation
Walter, S. A., Ragnarsson, G., & Bodemar, G. (2005) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2005.00305_5.x · Cited by 10 · see citing works
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Aguilera‐Lizarraga, J., Florens, M. V., Hussein, H., & Boeckxstaens, G. E. (2021) · Acta Clinica Belgica · doi:10.1080/17843286.2021.1996069 · Cited by 9 · see citing works
“with normal bowel habits alternating with either diarrhea and/or constipation with insufficient abnormality of stool consistency, referred to as unclassified (IBS-U, 24–60%) [15,16].”
BackgroundDiet and Irritable Bowel Syndrome, with a Focus on Appetite-Regulating Gut Hormones
El‐Salhy, M., Gundersen, D., Hatlebakk, J. G., & Hausken, T. (2014) · Elsevier eBooks · doi:10.1016/b978-0-12-407869-7.00001-5 · Cited by 9 · see citing works
Passos, M., Alvariz, R. C., André, E. A., Barbuti, R., Fillmann, H., Murad-Regadas, S., Rezende, J., Perrotti, M., & Guedes, L. S. (2022) · Arquivos de Gastroenterologia · doi:10.1590/s0004-2803.202200001-23 · Cited by 7 · see citing works
Is national socioeconomic status related to prevalence of irritable bowel syndrome?
Zhu, J., Yan, T., Yu, C., Wan, X., Wang, Y., & Li, Y. (2014) · Journal of Gastroenterology and Hepatology · doi:10.1111/jgh.12609 · Cited by 8 · see citing works
Epidemiology of Irritable Bowel Syndrome; A Systematic Review of Literature
Alosaimi, M., Alı̀, A., & Razzak, H. A. (2016) · Journal of health informatics in developing countries · Cited by 7 · see citing works
Pan, Z.-G., Xiao, C., & Su, D. (2014) · World Journal of Gastroenterology · doi:10.3748/wjg.v20.i20.6345 · Cited by 8 · see citing works
- Authors
- Guilera, M., Balboa, A., & Mearin, F.
- Affiliations
- Hospital Quirón Teknon (ES)
- Corresponding author
- Guilera, Magda
- Venue
- The American Journal of Gastroenterology
- Published
- 2005-05
- Volume
- 100
- Issue
- 5
- Pages
- 1174-1184
- ISSN
- 0002-9270 (ISSN-L)
- 1572-0241
- OpenAlex
- W2021290527
- Cited by
- 131
- References
- 45
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 1 · 2022: 5 · 2021: 6 · 2020: 2 · 2019: 6 · 2018: 4 · 2017: 8 · 2016: 4 · 2015: 9 · 2014: 15 · 2013: 5 · 2012: 7
- FWCI
- 1.55
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- 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, irritable bowel syndrome with constipation, diarrhea-predominant irritable bowel syndrome, clinical course, diagnostic criteria, Rome criteria, Manning criteria, symptom clustering
- MeSH terms
- Constipation, Defecation, Diarrhea, Follow-Up Studies, Humans, Intestines, Prospective Studies, Time Factors, Abdominal Pain, Irritable Bowel Syndrome
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