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Irritable bowel syndrome — master index¶
Last curated: 2026-10-28 · status: built · 20 of 20 pages written · 398 PubMed records plus 1 preprint (395 prior records plus 3 PubMed additions and 1 Research Square preprint verified 2026-10-28; resolution is not a fresh claim-level audit) · 7 landmark notes · 36-document guideline registry · 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. The 2026-09-02 audit promoted all 20; ten are now draft after subsequent sweeps and 10 retain their earlier curated status |
| Verified citations | 398 unique bibliography PMIDs plus 1 preprint DOI. All 2026-10-28 additions were retrieved live and checked against PubMed publication types and Crossref updated-by; prior condition identifiers were not re-audited at claim level |
| Clinical trial records | All 67 cited NCT identifiers individually re-fetched on 2026-10-28; snapshot 1,180 studies; new taVNS protocol (NCT07890948) and the completed Czech FMT trial (NCT04899869) added. No results-first-post date in this sweep window |
| Bibliography | literature/BIBLIOGRAPHY.md — 399 records (398 PubMed, 1 preprint) in 19 topic sections |
| Landmark notes | literature/notes/ — 7 papers |
| Guidelines registry | literature/guidelines/REGISTRY.md — 36 documents, 7 named disagreements, 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¶
Eleven pages retain status: curated from the 2026-09-02 audit. Diagnosis, epidemiology, microbiome, dietary therapy, the trials landscape, red flags, guidelines, brain–gut axis and functional-dyspepsia overlap are now status: draft after later sweeps. Line counts in this table are from the 2026-09-02 build and were not recounted. 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 | 28 |
| 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 | 27 |
| 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 | 1,179 registered studies on 2026-10-21; REFIT2 published and negative; rimegepant results posted and negative on pain | 172 | 13 + NCT list |
| 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 | 395 PubMed records in 19 topic sections; four 2026-10-14 catalogue-only entries still have no citing wiki page |
| 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/notes/johnsen-2026-refit2.md | REFIT2 — powered phase 3 of donor versus autologous FMT, negative |
| literature/guidelines/REGISTRY.md | 36 documents with supersession chains; 7 named disagreements; watch list. Israeli 2026 entry is abstract-level |
| 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. 11 retain their earlier curated status; 9 are draft pending independent audit |
| Literature layer | Bibliography 395; 7 notes; guidelines registry 36; statistics registry snapshot refreshed |
| Open questions | 30 tiered questions, 12 dots. OQ-29 sharpened on 2026-10-21; no new question |
| Audit | Independent audit on 2026-09-02 promoted 20/20 pages to curated. Pages edited after that audit are draft until a later audit re-promotes them |
Built by Claude on 2026-09-02. Sweep of 2026-09-30 added seven PMIDs, one landmark note, and the registry and trial-status updates in the log. Those older claim-level checks have not been repeated; identifiers were re-fetched for resolution on 2026-10-14.
2026-10-14 sweep. Eight bibliography additions (four catalogue-only), three guideline catalogue additions (two correcting older omissions), one new mechanism-selected trial, ARFID ascertainment update, refreshed trial counts, and a PDSB youth priority-setting event. No new landmark note or closed open question. Search manifest; details and source-access limitations in LOG.md.
2026-10-21 sweep. Two bibliography additions (UK Biobank morphometry null; FD GWAS with IBS genetic overlap), rimegepant registry results, a Rome V-eligibility SIMBA protocol, and refreshed trial counts. No new landmark note or closed open question. Search manifest; details in LOG.md.