IBS in Focus: Clinical Shifts Toward Patient-Centered Diagnosis and Care

New York, NY — At the 2025 Women’s Health Annual Visit (WHAV) session on irritable bowel syndrome (IBS), Kimberly Orleck, PA-C, alongside Dr. Brooks Cash (joining virtually), emphasized the evolution in diagnosing and managing IBS, a condition that remains both prevalent and frequently misunderstood. The discussion focused on refining the diagnostic process, improving patient care, and addressing the complex interplay of symptoms that define this chronic disorder.

IBS, classified as a disorder of gut–brain interaction, affects an estimated 35 million Americans, with prevalence rates ranging from 7% to 16%. Although more common in women, approximately 40% of patients are men, underscoring the need for inclusive recognition. The condition typically emerges in adolescence or early adulthood and carries both direct and indirect costs—up to $10 billion annually in the U.S. alone.

The Burden of Disease

Patients with IBS experience significant disruptions in quality of life. Symptoms often interfere with work productivity, social interactions, and family life. On average, patients lose 11 days of productivity per month, and up to 38% have contemplated suicide due to the severity of symptoms. High rates of comorbid anxiety and depression—affecting 40% to 50% of patients—further compound the burden.

From Exclusion to Positive Diagnosis

Historically, IBS was treated as a diagnosis of exclusion, often involving extensive and unnecessary testing. Orleck highlighted the shift to a positive diagnostic strategy, supported by the Rome IV criteria, which focus on recurrent abdominal pain associated with bowel habits. Despite clear guidelines, awareness and adoption remain limited—only up to 21% of providers report using the criteria in practice. This gap contributes to an average diagnostic delay of four years from symptom onset.

The Rome IV criteria emphasize pain as the central feature, supported by changes in stool form or frequency. Subtyping into IBS-C (constipation), IBS-D (diarrhea), or IBS-M (mixed) is aided by tools like the Bristol Stool Form Scale. Importantly, providers must rule out alarm features, such as unexplained weight loss, rectal bleeding, or family history of colorectal cancer, before confirming the diagnosis.

Patient-Centered Communication

Orleck stressed the importance of validating patient experiences. Many patients arrive at consultation after years of being dismissed, often told their symptoms are “in their head.” Educating patients on the brain–gut axis and the concept of visceral hypersensitivity helps them understand that their pain is real, even when routine testing appears normal. This reassurance can significantly improve trust, reduce stigma, and enhance satisfaction with care.

Pathophysiology and Contributing Factors

IBS is driven by multifactorial mechanisms, including:

• Altered GI motility

• Increased intestinal permeability

• Microbiome disturbances

• Visceral hypersensitivity

• Genetic predisposition

Post-infectious IBS is recognized in about 20% of cases, typically following bacterial or viral illness. Psychological stressors, early life trauma, and mental health conditions like anxiety and depression can also contribute to symptom development and severity.

Management Strategies

Dr. Cash emphasized that IBS should be treated as a syndrome of symptoms, not a singular disease. Management requires a multimodal approach:

Lifestyle and Diet

• Encourage physical activity

• Soluble fiber supplementation (e.g., psyllium) is preferred over insoluble fiber

• A supervised low-FODMAP diet can be helpful but should be implemented under the guidance of a registered dietitian

Pharmacologic Options

• OTC laxatives (e.g., PEG) may help with bowel function but generally do not relieve abdominal pain

• FDA-approved therapies for IBS-C:

  • Secretagogues: linaclotide, plecanatide, lubiprostone

  • Retainagogues: tenapanor

• FDA-approved therapies for IBS-D:

  • Rifaximin (antibiotic)

  • Eluxadoline (opioid receptor modulator)
    ⚠️ Note: Eluxadoline is contraindicated in patients without a gallbladder, those with a history of pancreatitis, or those who consume more than three alcoholic drinks per day.

  • Peppermint oil and other antispasmodics may aid in pain and bloating relief

Psychological Therapies

• Cognitive behavioral therapy (CBT)

• Gut-directed hypnotherapy

• Mindfulness-based therapies

These have shown efficacy in patients with comorbid mental health conditions or those with severe symptom distress.

Toward Multidisciplinary Care

Evidence supports a multidisciplinary care model that incorporates gastroenterology, nutrition, psychology, and physical therapy. According to data from the MANTRA trial, this approach yields significantly greater and more durable improvements in both symptoms and quality of life than standard care.

Key Takeaways

• IBS is highly prevalent, affecting up to 35 million Americans, yet remains underdiagnosed and undertreated.

• The Rome IV criteria provide a positive diagnostic framework centered on abdominal pain and bowel habit changes.

• Validating patient experiences and educating them on the brain–gut axis is critical to effective care.

• Management should combine dietary, pharmacologic, and psychological interventions, tailored to the patient's most bothersome symptoms.

• Multidisciplinary care improves long-term outcomes and patient satisfaction.

This session underscored the importance of adopting positive, patient-centered diagnostic strategies while leveraging a broad therapeutic toolkit to address the diverse needs of patients living with IBS.

This educational session at the Women’s Health Annual Visit (WHAV Meeting) was funded by an independent educational grant from Salix Pharmaceuticals and Ironwood Pharmaceuticals.