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Irritable bowel syndrome — master index¶
Last curated: 2026-09-02 · status: built, awaiting audit · 20 of 20 pages written · 364 verified citations · ~3,000 lines of wiki · 6 landmark notes · 32-document guideline registry · 250-row statistics sheet · 30 open questions · 12 dots-not-yet-connected
The condition in five sentences. Irritable bowel syndrome is a disorder of gut–brain interaction defined by a symptom rule and by the absence of anything else, so every quantitative claim about it inherits that definition: measured prevalence is 9.2% under Rome III and 3.8% under Rome IV in the same meta-analysis (Oka 2020, PMID 32702295), while Rome V — published in May 2026 — returns 8.5% globally and identifies a partly different group again, with agreement against its predecessors of only κ 0.36–0.55 (Sperber 2026, PMID 42613194; Staller 2026, PMID 42392123). Three decades of mechanistic work have produced reproducible peripheral and central abnormalities and no biomarker; only bile acid metabolism, colonic transit and psychological comorbidity are quantifiable with validated tests (Nasser 2026, PMID 42462748). What works is not principally pharmacological — dietary therapy beat optimised drug treatment in a specialist clinic (76%/71% vs 58%; Nybacka 2024, PMID 38643782) and a smartphone FODMAP app beat an antispasmodic in primary care (71% vs 61%; Carbone 2022, PMID 35483886) — while the two best non-dietary options are a cheap old drug (low-dose amitriptyline; Ford 2023, PMID 37858323) and a scarce therapy (brain–gut behavioural treatment; Everitt 2019, PMID 30971419). Placebo response runs at 27–37% depending on endpoint, open-label placebo works about as well as blinded placebo (Lembo 2021, PMID 33605656), and a randomised trial found that a drug label nearly doubled response while the drug itself did nothing (Rexwinkel 2025, PMID 40074185). Generic quality of life is comparable to stroke or COPD (EQ-5D 0.570; Goodoory 2023, PMID 36544055), enacted stigma is experimentally higher than for inflammatory bowel disease (Taft 2017, PMID 27501483), and 38% of tertiary-care patients have contemplated suicide because of their bowel symptoms (Miller 2004, PMID 15625650).
Start here: wiki/overview.md. Research frontier: OPEN-QUESTIONS.md. Growth history: LOG.md.
At a glance¶
| Layer | State |
|---|---|
| Wiki pages | 20 of 20 built, all status: draft pending independent audit |
| Verified citations | 364 unique PMIDs, each retrieved live from PubMed E-utilities on 2026-09-02 |
| Clinical trial records | 38 NCT identifiers, each retrieved live from the ClinicalTrials.gov v2 API on 2026-09-02 |
| Bibliography | literature/BIBLIOGRAPHY.md — 364 records in 19 topic sections |
| Landmark notes | literature/notes/ — 6 papers |
| Guidelines registry | literature/guidelines/REGISTRY.md — 32 documents, 7 named disagreements, 6 gaps, watch list |
| Statistics | literature/statistics/STATISTICS.md — 12 sections, ~250 rows, 10 named conflicts |
| Patient voice | literature/patient-voice/ — 4 files, 10 organisations, 7 themes |
| Open questions | OPEN-QUESTIONS.md — 30 questions (OQ-1 to OQ-30), 12 dots-not-yet-connected |
Reading paths¶
"I have 10 minutes." overview.md → the "Four things that are true and uncomfortable" section.
"I need to understand why the numbers disagree." diagnosis-and-rome-criteria.md → epidemiology-and-burden.md → placebo-response-and-trial-design.md. These three explain almost every apparent contradiction in the rest of the knowledge base: the criteria move the denominator, the endpoints move the responder rate, and the placebo response moves the effect size.
"What actually works?" dietary-therapy.md → psychological-therapy.md → gut-brain-neuromodulators.md → then the subtype-specific drug pages (constipation-predominant-pharmacotherapy.md, diarrhoea-predominant-pharmacotherapy.md) → guidelines.md for how societies sequence them, and where they disagree.
"What is the mechanism?" brain-gut-axis-and-visceral-hypersensitivity.md → post-infectious-ibs.md (the only route in with a datable start) → microbiome.md (the largest literature, the least clinical yield) → rifaximin-and-the-sibo-question.md (a drug that works and a construct that may not exist).
"What might I be missing in a patient?" differential-diagnosis-and-exclusion.md → red-flags-and-safety-concerns.md → overlap-with-functional-dyspepsia.md.
"What is it like to have this?" quality-of-life-and-stigma.md → literature/patient-voice/themes.md → back to placebo-response-and-trial-design.md, where the same phenomenon is measured from the trial side.
"What should be studied next?" OPEN-QUESTIONS.md → clinical-trials-landscape.md.
Scoping decisions (unchanged from the seed, re-confirmed at build)¶
This condition owns IBS, not disorders of gut–brain interaction generally. Functional dyspepsia overlaps in 34.6–55.3% of cases and is framed as overlap, with its own page; it is not curated as a condition. Other DGBI are out of scope and are candidates for future conditions.
Organic disease is a differential, not a subject. Inflammatory bowel disease, coeliac disease, microscopic colitis and bile acid diarrhoea appear on differential-diagnosis-and-exclusion.md and red-flags-and-safety-concerns.md, scoped strictly to how they are excluded and how often they are missed. IBD is not curated in this repository and was not built here.
The first curated condition in the digestive category, and deliberately not drug-spined. Diet, psychological therapy and the diagnostic label itself carry as much weight as pharmacotherapy, because that is where the evidence is. The build confirmed the seed's judgement: the two head-to-head trials against drug therapy (CARIBS, DOMINO) both favour diet, and brain–gut behavioural therapy has larger measured effects than any drug.
The placebo response is a page, not a caveat. In a condition diagnosed by symptom report and treated for symptom relief, the size and mechanism of the placebo response — including open-label placebo — is substantive evidence about the condition. The build added a second reason: two randomised experiments in this literature (the mebeverine labelling trial and the blinded FODMAP reintroduction) measure the informational component of treatment directly.
Criteria era is recorded with every effect estimate, per the build brief. Where a source's population was defined by Manning, Rome II, III, IV or V, the page says so.
Pages¶
All twenty pages are status: draft. This is the canonical page list per CONVENTIONS §5; link only to these filenames.
| # | Section | Page | Scope | Lines | Citations |
|---|---|---|---|---|---|
| 1 | Foundations | overview.md | What IBS is, why criteria-defined matters, map of the condition | 158 | 48 |
| 2 | Foundations | diagnosis-and-rome-criteria.md | Manning 1978 → Rome V 2026; accuracy of every criteria set; subtyping and its instability; latent-class alternative | 148 | 31 |
| 3 | Foundations | epidemiology-and-burden.md | Prevalence by criteria and region, sex and age, incidence and remission, cost of illness | 130 | 23 |
| 4 | Diagnosis | differential-diagnosis-and-exclusion.md | Coeliac, IBD, microscopic colitis, bile acid diarrhoea, EPI; test yields and miss rates | 128 | 22 |
| 5 | Mechanism | brain-gut-axis-and-visceral-hypersensitivity.md | Mechanistic map, barostat data, mucosal neuroplasticity, EC-cell circuit, genetics, bidirectionality | 132 | 27 |
| 6 | Mechanism | microbiome.md | Composition, gas microtypes, metabolites, probiotics, FMT contradiction | 174 | 37 |
| 7 | Mechanism | post-infectious-ibs.md | Incidence, pathogens, Walkerton, risk score, genetics, mucosal findings, anti-CdtB biomarker | 176 | 26 |
| 8 | Treatment | dietary-therapy.md | CARIBS, DOMINO, low FODMAP, reintroduction, fibre, costs of restriction | 138 | 25 |
| 9 | Treatment | antispasmodics-and-peppermint.md | Effect sizes, trial quality, mechanism, the mebeverine labelling experiment | 134 | 22 |
| 10 | Treatment | constipation-predominant-pharmacotherapy.md | Linaclotide, tenapanor, plecanatide, lubiprostone, tegaserod, laxatives; MD-7246 | 140 | 23 |
| 11 | Treatment | diarrhoea-predominant-pharmacotherapy.md | Eluxadoline and its harms, 5-HT3 antagonists, loperamide | 132 | 20 |
| 12 | Treatment | rifaximin-and-the-sibo-question.md | TARGET 1–3, neomycin, the contested SIBO construct, cost and access | 136 | 32 |
| 13 | Treatment | gut-brain-neuromodulators.md | ATLANTIS, class meta-analysis, agent by agent, mechanism | 166 | 23 |
| 14 | Treatment | psychological-therapy.md | Network meta-analyses, ACTIB, hypnotherapy durability, delivery and access | 148 | 21 |
| 15 | Method | placebo-response-and-trial-design.md | Magnitude, components, open-label placebo, nocebo, endpoints and instruments | 157 | 20 |
| 16 | Clinical | overlap-with-functional-dyspepsia.md | Co-occurrence, prognosis, shared cause, the duodenal hypothesis, wider overlap | 145 | 26 |
| 17 | Reference | guidelines.md | ACG, BSG, AGA, NICE, JSGE, Seoul, Italian, UEG/ESNM, APAGE, AMG, WGO — agreements and disagreements | 165 | 38 |
| 18 | Frontier | clinical-trials-landscape.md | 1,171 registered studies; live counts; novel mechanisms; what is missing | 172 | 12 + 38 NCT |
| 19 | Human | quality-of-life-and-stigma.md | Burden, work impairment, measured stigma, invalidation, patient expectations | 130 | 25 |
| 20 | Human | red-flags-and-safety-concerns.md | Alarm features, missed organic disease, drug harms, dietary harms, suicidality | 185 | 49 |
Literature layer¶
| File | Contents |
|---|---|
| literature/BIBLIOGRAPHY.md | 364 records, 19 topic sections, each with cited by page list |
| literature/notes/ford-2023-atlantis.md | ATLANTIS — largest tricyclic trial in IBS, in primary care |
| literature/notes/nybacka-2024-caribs.md | CARIBS — diet versus optimised drug therapy |
| literature/notes/pimentel-2011-target.md | TARGET 1/2 — rifaximin, and the construct problem it created |
| literature/notes/kaptchuk-2008-placebo-components.md | Components of the placebo effect — the relationship as a dose |
| literature/notes/marshall-2010-walkerton.md | Walkerton — 8-year prognosis of post-infectious IBS |
| literature/notes/eijsbouts-2021-gwas.md | GWAS of 53,400 cases — shared pathways with mood and anxiety |
| literature/guidelines/REGISTRY.md | 32 documents with supersession chains; 7 named disagreements; 6 gaps; watch list |
| literature/statistics/STATISTICS.md | 12 sections: prevalence, demography, subtypes, natural history, post-infectious, diagnostic performance, test yield, treatment effects, placebo, burden, stigma/safety, research activity; 10 named conflicts |
| literature/patient-voice/ | Method and ethics, 10 organisations (with retrieval outcomes recorded honestly, including one repurposed domain), 7 themes each with ≥2 sources, annotated sources with coverage limits |
Curation state¶
| Layer | State |
|---|---|
| Wiki pages | 20 of 20 built, all status: draft |
| Literature layer | Complete: bibliography, 6 notes, guidelines registry, statistics, patient voice |
| Open questions | Rebuilt: 30 tiered questions, 12 dots-not-yet-connected, every asserted absence searched and dated |
| Audit | Not yet performed. A different engine must audit before any page is promoted to curated; the log entry must name both engines |
Built by Claude on 2026-09-02. Every PMID was retrieved from PubMed E-utilities and every NCT from the ClinicalTrials.gov v2 API during that session. Nothing here was promoted to curated by its author.