Irritable Bowel Syndrome

肠易激综合症 · IBS

Place · Level 3

Rome IV 全球约 4% · 分型 IBS-D/C/M · 低 FODMAP 三阶段 · 肠脑轴 · SIBO 测试陷阱 · 红旗清单

Connected to · 7

synergy · 1

Probiotics
Ford 2018 AGA meta: strain-specific — Lacto + Bifido blends help IBS-M/IBS-D global symptoms at B-tier evidence; 'broad-spectrum' is mostly a category error.

regulates · 4

Depression & Anxiety
Gut-brain axis is bidirectional: 40-60% of IBS patients have depression/anxiety; anxiety/depression independently provokes IBS symptoms. Shared serotonin (95% gut + 5% brain). Treating one often treats both — but SSRI/TCA dosing in IBS differs from psychiatric use.
Digestive
IBS is not only a bowel problem — it sits on the gut-brain axis, where the vagus runs both ways and about 80% of its fibres are afferent (gut to brain). That is a fibre count, not a measure of signal traffic — the two are routinely conflated. Looking for a lesion in the bowel alone usually finds nothing and moves nothing.
Gut Microbiome
Low-FODMAP is a structured diagnostic diet: short, dietitian-guided, with systematic reintroduction. Held strictly long term it starves the microbiome instead.
Microplastics
A path that gets cited a lot but whose evidence is still early: particles may lower tight-junction proteins (claudin, occludin), loosening the gut barrier while shifting microbial composition. The link to IBS is currently association, not causation.

contrast · 2

Foodborne Illness
Foodborne illness is acute; recurring long-term diarrhoea or abdominal pain is a different problem, and treating chronic gut symptoms as one more bad meal misses the work-up that is actually needed.
Berberine
Berberine with neem and oregano oil is sold as a personalised protocol in SIBO clinics, with no RCT behind it and no safety case either. The route is gastroenterology, Rome criteria and red-flag screening.

Rome IV · 4 subtypes

Stop 1/5

Rome IV 标准 · 4 种分型

Irritable Bowel Syndrome (IBS) is a functional bowel disorder: structurally the intestine has no visible lesion, but motility / sensation / microbiome / gut-brain axis goes wrong. How common it is depends on which version of the criteria you count with: in the Rome Foundation's 33-country survey the same respondents give 4.1% under Rome IV and 10.1% under the looser Rome III — the spread is the criteria, not the population. This article uses Rome IV throughout, so the number here is about 4%; the widely quoted 'global 5-10%' is a Rome III-era figure. Women ~2× men, average diagnostic delay 4 years.

Rome IV criteria (2016)

Core: recurrent abdominal pain, averaging at least 1 day/week, for ≥3 months (onset ≥6 months prior), plus ≥2 of:

Related to defecation (before / after / no change)Associated with change in stool frequencyAssociated with change in stool form
4 subtypes (by Bristol stool scale):

IBS-D (diarrhea): >25% loose/watery, <25% hardIBS-C (constipation): >25% hard, <25% loose/wateryIBS-M (mixed): both loose/watery and hard >25%IBS-U (unclassified): doesn't fit above
Key: IBS is NOT a diagnosis of exclusion

The first of the ACG 2021 guideline's 25 recommendations is exactly the opposite of the folk version: use a positive diagnostic strategy rather than a strategy of exclusion — explicitly in order to shorten time to appropriate therapy. Meet the symptom criteria with no red flags, and treatment can begin alongside a limited work-up.

Limited work-up to rule out: IBD (ulcerative colitis / Crohn's) / lactose intolerance / celiac disease / microscopic colitis / colorectal cancerBasic blood: CBC + + celiac antibodies (tTG-IgA) + Stool: occult blood + calprotectin whenever there are diarrhea symptoms — the guideline sets no age threshold; an 'age 40+' rule would miss the 15-35 peak incidence of IBDColonoscopy: red flags / family history / red flags
Why a dedicated atlas island?

Severely undertreated: 50% of patients never see a doctor, 60% use OTC ineffectivelyDietary intervention (low FODMAP) actually works, but is extensively misreported (next scene)Marketing hotbed for 'SIBO testing ads' + 'candida detox' + 'leaky gut syndrome'

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Educational content, not medical advice — consult a clinician.

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