Irritable bowel syndrome (IBS), a disorder of gut-brain interaction, can present with a variety of gastrointestinal (GI) and extraintestinal symptoms. Treating severe cases can be challenging and requires a multifactorial approach, according to a guide published in Gastroenterology.

Adequate communication from the provider plays a vital role in helping patients navigate and manage IBS. Explaining pathophysiologic processes promotes the acceptance of a diagnosis that lacks objective diagnostic criteria.

Establishing treatment expectations and associated timelines can help mitigate patient frustration. Open communication also provides the patient ample opportunity to share the most troublesome symptoms and their effects on daily living.

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The Rome multidimensional clinical profile consists of five components to guide provider treatment decisions:

  • Categorical Rome diagnosis using the Rome diagnostic criteria
  • Clinical modifiers (IBS with constipation [IBS-C], IBS with diarrhea [IBS-D], related comorbidities)
  • Impact on daily activities
  • Psychosocial modifiers
  • Physiological features and biomarkers

The categories are designed to assist clinicians in optimizing a treatment regimen that addresses the full clinical picture, such as using a tricyclic antidepressant in a patient who suffers from IBS-D and insomnia.

The complexity of IBS requires dietary assessment and modification, pharmacologic intervention, and behavior modification through therapy. This multifactorial approach is recommended to optimize patient outcomes and improve patient satisfaction.

Disclosure: The author declared affiliations with biotech, pharmaceutical, and/or device companies. Pleases see the original reference for a full list of author disclosures.


Chang, L. How to approach a patient with difficult to treat IBS. Gastroenterol. Published online July 28, 2021. doi:10.1053/j.gastro.2021.07.034

This article originally appeared on Gastroenterology Advisor