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Curation log — irritable bowel syndrome

Newest entries first. Every content-changing session appends an entry: date, what changed, what was searched, follow-ups for next time. See CLAUDE.md.

2026-10-28 — Literature sweep (Claude; independent audit pending)

Window and sources actually queried. Inclusive 2026-10-21–2026-10-28. The 19 PubMed topic queries from the 2026-10-21 manifest were re-run verbatim through E-utilities with the window replaced (PDAT OR EDAT). Each was paired with "Cochrane Database Syst Rev"[jour]. The union was 31 PubMed records, and all 19 dated CDSR searches returned zero. A whole-year 2026 CDSR query for IBS and functional bowel terms, and a window-dated CDSR query on the main IBS interventions, also returned zero. Thirteen supplemental dated searches covered: - German S3 and CAG successors - a Rome V guideline - REFIT2 follow-up - adult suicidality - open-label placebo - post-infectious prevention - pipeline agents - GLP-1 in IBS - Rome IV/V mortality - eating disorders - head-to-head neuromodulator versus behavioural therapy

Europe PMC REST was queried for all 19 topics, returning 3–152 screening hits per topic; these are not distinct new papers. That surfaced three preprints not in PubMed. Crossref was used for DOI and retraction checks. The PubMed MCP server was disconnected this session, so E-utilities were used directly. Exact queries, translations, IDs and checks are in the published search manifest.

ClinicalTrials.gov and non-US registries. All 67 NCT identifiers cited in the condition were re-fetched individually, and all returned matching IDs. Only NCT07522255 (Mahidol rifaximin, bloating) changed: estimated start moved to 2026-12 in a 2026-10-27 update. The paginated query.cond snapshot returned 1,180 studies (recruiting 103, not-applicable phase 598, vagus intervention query 12; the other counts are unchanged). Six snapshot records were updated in the window and one was first posted: NCT07890948, a taVNS sham-controlled crossover, n=40, not yet recruiting. None has a results-first-post date in the window. A registry search for the Czech FMT preprint found NCT04899869 (MISCEAT, Thomayer University Hospital; completed 2024-03-27; 61 enrolled; no results posted). The ISRCTN XML API lastEdited window query returned totalCount="0". WHO ICTRP returned 200 but is JavaScript-driven and was not searched as a database.

What survived triage. Three PubMed additions and one preprint. No landmark note; no new guideline document. 1. FMT, preprint. Cinek 2026 (Research Square doi:10.21203/rs.3.rs-11289849/v1, not peer reviewed) was a three-arm double-blind crossover in 61 IBS-D/IBS-M adults, with 50 in the efficacy analysis, using pooled multi-donor material from bacteriome-preselected donors. The primary IBS-SSS endpoint was null (2.5 points, 95% CI −33.6 to 38.6; p=0.893), while donor strains engrafted. It was added to the microbiome FMT table and the trials FMT table, and OQ-13 was sharpened. The NCT link is a match on authors, design and enrolment; the preprint abstract does not print it. The MISCEAT protocol paper (Hurych 2022, PMID 35760542) was added as the link's support. The preprint full text was not read. 2. Coeliac in Japan, full text read. Higashiyama 2026 (PMID 42904019) screened 583 patients with disorders of gut–brain interaction at 23 centres: 562 with IBS by Rome III questionnaire and 21 with FD. One was tTG-positive and biopsy-confirmed (IBS-D, Marsh 3a), giving 0.17%. Numbers were taken from Table 1 of the open-access text (Europe PMC PMC13682709). The authors' own limitations were that total IgA and gluten intake were not measured. It was added to the differential page beside the Shiha 2025 / Irvine 2017 disagreement, and to statistics. 3. Chile, abstract-level. von Muhlenbrock 2026 (PMID 42928586) found Rome IV community prevalence of 25.7% urban versus 30.9% rural/Mapuche (aOR 1.18, 0.68–2.05). Among 8,717 gastroenterology outpatients, 36.2% in the public hospital versus 23.3% in the private one met criteria. It was added to the epidemiology page, the statistics sheet and OQ-27. The Wiley full text was not opened.

Seen and not incorporated. - Shiha & Aziz 2026, "Irritable bowel syndrome and suicide risk" (Gastroenterology, PMID 42906826): no abstract, content unknown. This is the item most likely to matter next week. - Camilleri & Ford 2026, GLP-1 RA commentary (PMID 42918357): no abstract. - Cureus rifaximin meta-analysis (PMID 42927267): very-low certainty; significance lost after excluding high-risk trials. - Plecanatide meta-analysis mixing CIC and IBS-C (PMID 42934540). - Zonulin narrative systematic review (PMID 42940160). - Low-FODMAP Bifidobacterium vote-count review (PMID 42903081). - Eluxadoline Medicare Part D utilisation (PMID 42909825). - Calprotectin reagent study with 56 IBS patients (PMID 42910145). - Maastricht microbiota phenotypes (PMID 42833252). - Colonic-transit mediation analysis, n=56 (PMID 42923306). - A paediatric Enterosgel protocol (adult-scoped). - Preclinical, acupuncture and TCM papers, and narrative reviews. - medRxiv All of Us psychological-health and Research Square multi-omics preprints.

Guidelines, statistics and patient organisations. NICE CG61 was re-read: still "Last reviewed: 30 April 2025", no clinical-management update. The DGVS and AWMF pages returned 200, but no successor text was found in the extracted page content. PubMed searches for German S3, CAG and Rome V guidelines returned none in the window. No new population-burden statistic beyond the Chilean figure. The Charity Commission record for 1173208 still reads Removed charity. The PDSB 31 October workshop page is unchanged (article:modified_time 2026-09-30). IFFGD, About IBS and badgut.org returned 403 this session. World IBS Day and ibspatient.org returned 200, and no new dated campaign was selected.

Limits. CENTRAL was not searched (cochranelibrary.com 403). SciELO and LILACS returned HTTP 403, which matters directly for the Chilean figure: its regional context could not be assessed. Unpaywall was skipped because LIFEBANK_CONTACT_EMAIL was unset, and Crossref was queried without mailto. A disk-full (ENOSPC) error interrupted the session mid-sweep. No repository file had been written before it, and all writes followed recovery.

Integrity and files. All four additions were retrieved live and checked for retraction or concern publication types and Crossref updated-by; none was flagged. The bibliography is now 398 PubMed records plus 1 preprint. Four wiki files were edited, all draft: microbiome, differential-diagnosis (demoted from curated), epidemiology, and clinical-trials. The condition is now 10 curated / 10 draft. INDEX, OPEN-QUESTIONS, bibliography, statistics and this log were updated, plus the one permitted sweep JSON. The guideline registry and patient-voice files were not changed: nothing new survived. No other condition, shared file, frontend or publishing script was touched. No strict site build was run.

Next sweep. - Open Shiha 2026 (PMID 42906826) and establish whether it is primary suicidality data bearing on D11/OQ-15. - Seek the Cinek preprint full text for the registration number and route, and watch for its peer-reviewed version. - Seek the Chilean full text for sampling details. - Recheck REFIT2 full text and registry lag; the camlipixant and brenipatide readouts; results for ebastine–mebeverine, paediatric tenapanor and the virtual dietitian; and NCT07882953 / NCT07890948 enrolment. - Check the German S3 2021 and CAG 2019 successors and any Rome V management guideline. - Look for a published PDSB workshop agenda after 31 October. - Carry forward from earlier sweeps: the Gao 2026 and Díaz-Muñoz 2026 full texts, and the four 2026-10-14 catalogue-only papers.

2026-10-21 — Literature sweep (Grok; independent audit pending)

Window and sources actually queried. Inclusive 2026-10-14–2026-10-21. Nineteen PubMed E-utilities topic searches used PDAT OR EDAT date ranges, each paired with "Cochrane Database Syst Rev"[jour]: overview; Rome/diagnosis; epidemiology/burden; differential/safety; brain–gut; microbiome/FMT/probiotics; post-infectious IBS; diet; antispasmodics; IBS-C; IBS-D; rifaximin/SIBO; neuromodulators; psychological therapy; placebo/design; dyspepsia overlap; guidelines; patient experience; novel programmes. Union: 41 PubMed records; all 19 dated CDSR searches returned zero. The [dp]-only probe returned 7. Supplemental searches covered German/Canadian guideline successors, Rome V guideline, REFIT2 follow-up, adult suicidality, criteria-stratified treatment, pipeline readouts, the four 2026-10-14 catalogue-only PMIDs, and an FMT-review window. Europe PMC REST was queried for all 19 topics; the broad overview returned 150 screening records, including older archive deposits, duplicate MED/PMC records and off-topic full-text matches, not 150 new IBS papers. All exact queries, PubMed translations, IDs and selected-record checks are in the published search manifest.

ClinicalTrials.gov and non-US registries. All 66 NCT identifiers tracked this session (the prior 64 plus NCT07872514 and NCT04074421) were individually re-fetched and matched their requested IDs. A paginated query.cond=irritable bowel syndrome API snapshot returned 1,179 studies, confirmed by a separate total-count request. Status totals: 705 completed, 102 recruiting, 57 not yet recruiting, 20 active/not recruiting, 63 terminated, 25 withdrawn, 14 invitation-only, 4 suspended, 188 unknown and 1 no longer available; these ten sum to 1,179. Phase tags via filter.advanced: 44 phase 1, 177 phase 2, 106 phase 3, 80 phase 4, 597 not applicable, 8 early phase 1; they are not a partition. Twenty-one phase 3 records start on/after 2021-01-01. Intervention queries: probiotic 134, FODMAP 99, CBT 51 (was 50), FMT 37, rifaximin 27 (was 26), linaclotide 27, hypnotherapy 22, acupuncture 18, vagus 11, tenapanor 9, amitriptyline 4, ebastine 4. Seven snapshot records were updated in the inclusive window and two first posted; none has a results-first-post date in the window. ISRCTN's documented XML API returned totalCount="2" for lastEdited in the window (ISRCTN15681288 and ISRCTN65517362, both Enterobiotix EBX-102-02; no matching ClinicalTrials.gov record in a condition-plus-intervention query for EBX-102). WHO ICTRP's portal returned HTTP 200 but is JavaScript-driven and was not searched as a database. ANZCTR, ChiCTR and CTRI pages returned 200 as reachability checks, not structured searches. The Iranian registry request for the agomelatine paper timed out.

What survived triage. Two bibliography additions; no new landmark note; no new guideline document.

  1. Full-text blocked, abstract-level wiki. Gao 2026 (PMID 42710640): UK Biobank DHQ-derived IBS phenotype vs matched controls, N = 3,413 each, versus a healthy reference of 8,661, found no robust cortical morphometry group differences; equivalence tests were statistically equivalent to negligible effect sizes across nearly all regions. Added to the brain–gut page beside Zhao 2023. Elsevier full text was not opened.
  2. Full-text blocked, abstract-level wiki. Díaz-Muñoz 2026 (PMID 42897685): FD GWAS in 1,168,899 European individuals (29,584 cases); SNP heritability 3.63%; Mendelian randomization of depression and anxiety onto FD; local genetic correlation with IBS including HLA; DHX36 prioritized. Added to the overlap page as shared architecture, not as a treatment-modifier result. Wiley full text was not opened.
  3. Registry results, not a new publication. NCT06221111 rimegepant 75 mg every other day, 4 weeks, non-constipation IBS pain: 24 analysed of a registry enrolment of 39; primary 100-mm VAS abdominal-pain change median −12 (IQR −16.9 to −6.4) vs −22.6 (−30.3 to −8.1), p=0.41. Results first posted 2026-05-22 (outside this window); last update 2026-10-15. Numbers taken from the live ClinicalTrials.gov results API this session.
  4. New protocol. NCT07882953, first posted 2026-10-20: University of Calgary SIMBA capsule plus open-label rifaximin, planned n=180, not yet recruiting, Rome V subtype eligibility. Added to the trials microbiome table; OQ-29 now distinguishes Rome V eligibility from criteria-stratified treatment effects.
  5. Guidelines. NICE CG61 re-read 2026-10-21: still last reviewed 30 April 2025, no clinical-management update planned. Dated PubMed/Europe PMC guideline queries found no new comprehensive IBS society guideline. German S3 successor still in progress on the DGVS page; no CAG successor.

Priority follow-ups checked. REFIT2 full text remained blocked (Lancet Cloudflare challenge). NCT04691544 still active/not recruiting, last update 2024-02-26, no results. Camlipixant and both brenipatide studies remain recruiting without registry results. Ebastine–mebeverine remains active/not recruiting; paediatric tenapanor and the virtual-dietitian study remain completed without registry results. NCT07872514 unchanged. Charity Commission record for 1173208 still reads Removed charity. PDSB youth workshop page is still the 31 October 2026 event; article:modified_time 2026-09-30; no published final agenda. Springer returned HTTP 200 for the agomelatine paper; numbers were not re-synthesised from that HTML. FMT-review full text remained blocked.

Seen and not incorporated. Emotion-regulation RCT n=40 (PMID 42901246; usual-care control, FS-BSS, no effect sizes in the abstract). Berberine combination meta-analysis of 19 RCTs (PMID 42877511; GRADE insufficient). Coeliac-on-GFD DGBI survey (PMID 42888891; reverse of this condition's differential scope). PI-IBS COVID-era case series (PMID 42882190; case composition, not incidence). FM+IBS n=33 characterization, juvenile-fibromyalgia DGBI, preclinical ion-channel and TCM papers, narrative reviews, and an endometriosis comorbidity SR. Europe PMC deposited Krause/Chang Rome V (PMID 42857891 / PMC13653318), already in last sweep's PubMed window. Paediatric psyllium NCT07880327 was first posted in the window and was not added (adult-scoped). No new population-burden statistic survived triage.

Other source checks and limits. Direct requests covered NICE, DGVS, CAG PDF, ACG, AGA, Guts UK, IFFGD, About IBS, badgut.org, World IBS Day, IBS Patient Support Group, MAGDA, PDSB, Rome Foundation, IHME, Charity Commission, Lancet REFIT2, Springer agomelatine, and MDPI FMT review. World IBS Day and ibspatient.org returned 403 this session; IFFGD, About IBS, badgut.org, ACG, AGA and Guts UK returned 200 (previously often 403) without a new dated campaign selected for addition. CENTRAL was not searched; Cochrane Library remains blocked per SOURCES.md. SciELO returned HTTP 403; LILACS timed out; regional transportability cannot be settled from the databases we can reach. Unpaywall was skipped because LIFEBANK_CONTACT_EMAIL was unset; Crossref was queried without mailto or a personal address.

Integrity and files. Both bibliography additions were fetched as primary PubMed records and checked for retraction/concern publication types and Crossref updated-by; none was flagged. Bibliography now 395 PubMed records. Three wiki files were edited (brain–gut, overlap, trials), all draft; condition state is 11 curated / 9 draft. INDEX, OPEN-QUESTIONS, bibliography, guideline registry, statistics and this log were updated. No other condition, shared source file, frontend, publishing script, git metadata or deployment was changed. The exact permitted sweep JSON is the only new source artifact.

Local validation. The two added PMIDs matched live PubMed records; Crossref updated-by was empty. New NCT identifiers NCT07882953, NCT06221111 (results) and the two ISRCTN IDs were returned by live APIs. Edited wiki frontmatter is dated 2026-10-21 and remains draft. No full publishing or strict site build was run, because publishing is handled after this task. These are mechanical/source checks, not an independent claim audit.

Next sweep. Seek accessible full text for Gao 2026 and Díaz-Muñoz 2026 (FD GWAS) before treating their abstract numbers as table-verified. Seek full text for the four 2026-10-14 catalogue-only papers. Retry the Iranian registry for agomelatine. Track NCT07882953 and NCT07872514 for enrolment and outcomes; do not confuse registration with clinical validation. Recheck REFIT2 full text/secondary endpoints and registry lag; camlipixant/brenipatide readouts; results for ebastine, paediatric tenapanor and the virtual dietitian. Check actual successors to German S3 2021 and CAG 2019, plus any Rome V management guideline. Follow the PDSB workshop for a published final agenda after 31 October. The adult multi-tier suicidality-replication question and an IBS Network successor remain open; the Charity Commission record is still removed. Refresh those scoped searches before repeating an absence.

2026-10-14 — Literature sweep (Codex; independent audit pending)

Window and sources actually queried. Inclusive 2026-09-30–2026-10-14. Nineteen PubMed E-utilities topic searches used PDAT OR EDAT date ranges, each paired with "Cochrane Database Syst Rev"[jour]: overview; Rome/diagnosis; epidemiology/burden; differential/safety; brain–gut; microbiome/FMT/probiotics; post-infectious IBS; diet; antispasmodics; IBS-C; IBS-D; rifaximin/SIBO; neuromodulators; psychological therapy; placebo/design; dyspepsia overlap; guidelines; patient experience; novel programmes. Union: 78 PubMed records; all 19 dated CDSR searches returned zero. Supplemental searches covered the prior follow-ups and unrestricted German/Canadian guideline history; the Rome V review found there was screened, not treated as a new management guideline. Europe PMC REST was queried for all 19 topics; the broad overview returned 293 screening records, including older archive deposits, duplicate MED/PMC records, off-topic full-text matches and two preprints, not 293 new IBS papers. The guideline query was corrected to remove PubMed-only syntax. All exact queries, PubMed translations, IDs, availability and selected-record checks are in the published search manifest.

ClinicalTrials.gov and non-US registries. All 64 NCT identifiers already present in the condition, including the diet study cited only in the earlier log, were individually re-fetched and matched their requested IDs. A paginated query.cond=irritable bowel syndrome API snapshot returned 1,177 studies, confirmed by a separate total-count request. Status totals now reconcile: 703 completed, 102 recruiting, 56 not yet recruiting, 21 active/not recruiting, 63 terminated, 25 withdrawn, 14 invitation-only, 4 suspended, 188 unknown and 1 no longer available. The omitted final category explains why the earlier nine-category table did not partition its total. Phase tags: 43 phase 1, 177 phase 2, 106 phase 3, 80 phase 4, 596 not applicable; they are not a partition. Twenty-one phase 3 records start on/after 2021-01-01. Separate intervention queries give probiotic 134 (previously 133); the other 11 tracked intervention totals are unchanged. Thirteen snapshot records were updated in the inclusive window and five first posted; none has a results-first-post date in the window. This is a current-record comparison, not reconstruction of every intermediate version. ISRCTN's documented XML API returned totalCount="0" for condition:"irritable bowel syndrome" AND lastEdited GE 2026-09-30T00:00:00 AND lastEdited LE 2026-10-14T23:59:59. WHO ICTRP returned 403, ANZCTR was blocked, and the Iranian registry request for the agomelatine paper's registration timed out. Those are access failures, not negative searches.

What survived triage. Eight bibliography additions; no new landmark note.

  1. Full-text verified clinical update. Mikhael-Moussa 2026 (PMID 42823900): dietary therapy, red flags, statistics and OQ-5 now distinguish NIAS-Fr positivity (155/326; 47.5%) from the study-defined DSM-5-compatible classification (109/326; 33.4%; full-text Table 2). Table 1 and Methods §2.3 show chart-based impairment plus an IBS-QOL food-avoidance threshold, not a specialist-confirmed ARFID diagnosis. This is retrospective tertiary-care ascertainment, not population prevalence or incidence caused by dietary treatment. No causal dietary-harm claim was added.
  2. New protocol changes a previous absence. NCT07872514, first posted 2026-10-13: McMaster plans 30 adults in masked randomized n-of-1 probiotic/placebo crossovers, selecting the probiotic using screening histamine or LPC/LPA. Enrolling by invitation, no registry results. Added to microbiome and trials pages; D5/OQ-4 now ask whether selection works and generalises, rather than claiming no prospective selection is being attempted. A registry protocol does not establish a validated diagnostic or treatment benefit.
  3. Guidelines. Soifer 2026 (PMID 42816255), Argentine breath-test/microbial-overgrowth consensus, is catalogued as adjacent and abstract-only; recommendations and grades were not synthesized from its abstract. Two older omissions were corrected after unrestricted live queries: German S3 2021 (PMID 34891206; PubMed's title is [Not Available], resolved by its DOI through Crossref and the DGVS version page) and CAG 2019 (PMID 31294724; full text opened). The 2011 German entry is superseded by 2021; DGVS says further revision is in progress. These are historical corrections, not new fortnight publications. Registry now 36 documents. NICE CG61 was re-read and still says reviewed 30 April 2025, with no clinical-management update planned. The guideline wiki's document table and follow-up list were corrected without re-appraising every older recommendation.
  4. Bibliography only. Aumpan FMT systematic review (PMID 42162772); Zhong probiotic consolidation after rifaximin RCT (PMID 42609157); Talebi agomelatine RCT (PMID 42844310); Rämisch PIONEER-IBS pilot (PMID 42837716). Metadata/abstract screening justified retaining them, but inaccessible full text prevents source-table verification, so no quantitative efficacy synthesis or deep note was added. Their issue dates can fall inside this window despite earlier online publication. The agomelatine registration was not independently verified and is not cited as a registry finding.
  5. Patient material. PDSB's youth IBS/functional-abdominal-pain research-priority workshop page was retrieved: published 23 August, modified 30 September 2026, event scheduled 31 October. Added to organisation notes and annotated sources as a planned youth priority-setting event, not a completed agenda or adult therapeutic evidence. No individual patient story or forum content was collected.

Priority follow-ups checked. REFIT2 full text remained blocked at the publisher; the Elsevier text-mining endpoint did not yield usable full text. NCT04691544 still lists active/not recruiting, last update 2024-02-26, with no results. No secondary or ≥50-point result was inferred. Camlipixant and both brenipatide studies remain recruiting without registry results; brenipatide records were updated 2026-10-08 with unchanged planned enrolments and status. Ebastine–mebeverine remains active/not recruiting; paediatric tenapanor and the virtual-dietitian study remain completed without registry results.

Seen and not incorporated. The plant-preparation review (PMID 42572206; full text available) did not justify replacing the existing fibre/peppermint syntheses. The exploratory virome classifier (PMID 42861963), microbiota phenotypes (PMID 42833252), food-expectation instrument (PMID 42860910), regional AEGIS symptom survey (PMID 42861429), post-hoc tenapanor analysis (PMID 42859374), broad narrative reviews, preclinical studies and IBD-scoped reports were not used to expand the wiki. The Europe PMC preprints were screened and not cited: single-arm food-as-medicine outcomes and an imaging meta-analysis did not warrant a new claim. No new population-burden statistic survived triage; World IBS Day's population-times-assumed-prevalence counter was not adopted as measured burden.

Other source checks and limits. Direct requests covered NICE, DGVS, CAG (official guideline PDF retrieved; requested library URL 404), ACG, AGA, IHME (requested IBS page 404), Guts UK, IFFGD/About IBS, badgut.org, World IBS Day, IBS Patient Support Group, MAGDA, PDSB, Rome Foundation and the Charity Commission. Programmatic ACG/AGA/Guts UK/IFFGD/About IBS/badgut/Charity Commission requests were blocked; web-tool retrieval/search results supplied some public organisational pages, not a successful direct request to those blocked endpoints. World IBS Day and IBS Patient Support Group homepages were retrieved but yielded no new dated campaign selected for addition. No IBS Network successor was verified, so none is signposted. CENTRAL was not searched; Cochrane Library remains blocked per SOURCES.md. SciELO and LILACS could not be searched (HTTP 403); regional transportability and patient-voice coverage cannot be settled from these sources. Unpaywall was skipped because LIFEBANK_CONTACT_EMAIL was unset; Crossref was queried without mailto or a personal address.

Integrity and files. All eight additions were fetched as primary PubMed records and checked for retraction/concern publication types and Crossref updated-by; none was flagged. The initial Argentine Crossref request was rate-limited and its successful sequential retry was used. Existing condition identifiers were additionally re-fetched for resolution (406 unique IDs including historical/excluded log references); that is not a claim-level audit. Bibliography now 393 PubMed records; four additions have no citing wiki page. Five wiki files were edited (diet, safety, microbiome, trials, guidelines), all draft; condition state is 13 curated / 7 draft because diagnosis and epidemiology were already draft. INDEX, OPEN-QUESTIONS, bibliography, guideline registry, statistics, two patient-voice files and this log were updated. No other condition, shared source file, frontend, publishing script, git metadata or deployment was changed. The exact permitted sweep JSON is the only new source artifact.

Local validation. All identifiers in edited markdown matched live API responses; the eight additions passed both retraction checks. Bibliography total/topic counts, wiki body-to-reference coverage and reference numbering passed. New local links resolved, and the actual site-builder mapping/transform functions confirmed literature/sweeps/2026-10-14.json publishes as sweeps/2026-10-14.json. Edited wiki frontmatter is dated 2026-10-14 and remains draft. No full publishing or strict site build was run, because publishing is handled after this task. These are mechanical/source checks, not an independent claim audit.

Next sweep. Seek accessible full text for the four catalogue-only papers, especially the FMT review's eligible trial set and the two drug/consolidation RCTs, before incorporating numerical outcomes. Retry the Iranian registry for agomelatine. Track NCT07872514 for protocol refinements, actual enrolment and outcomes; do not confuse registration with clinical validation. Recheck REFIT2 full text/secondary endpoints and registry lag; camlipixant/brenipatide readouts; results for ebastine, paediatric tenapanor and the virtual dietitian. Check actual successors to German S3 2021 and CAG 2019, plus any Rome V management guideline. Follow the PDSB workshop for a published final agenda after 31 October. The adult multi-tier suicidality-replication question and an IBS Network successor remain open; refresh their scoped searches before repeating an absence.

2026-09-30 — Literature sweep

Window. Publications since the 2026-09-02 audit. PubMed E-utilities were run twice: ("2026/09/02"[PDAT] : "2026/09/30"[PDAT]) and ("2026/09/03"[EDAT] : "2026/09/30"[EDAT]), each crossed with topic queries (Rome, epidemiology, differential diagnosis, brain–gut, microbiome, post-infectious, diet, antispasmodics, IBS-C, IBS-D, rifaximin/SIBO, neuromodulators, psychological therapy, placebo, functional-dyspepsia overlap, guidelines, quality of life, safety, and the dated gaps below). Unique PMIDs in the union: 96. One was already cited (Sperber, PMID 42613194). ClinicalTrials.gov v2: all 63 NCT identifiers already cited in this condition were re-fetched; a query.cond = "irritable bowel syndrome" snapshot was taken the same day. NICE CG61 was re-read. Patient-organisation URLs were requested; most did not return usable text (below). The prior 378 PMIDs were not re-fetched.

What survived triage.

  1. Landmark. Johnsen 2026, PMID 42785338 (REFIT2), with the empty-abstract commentary Liu 2026, PMID 42785337. Phase 3, five Norwegian hospitals, Rome IV, IBS-SSS ≥175, ages 18–65, once-only rectal enema, healthy donor versus autologous, 2:1. Primary endpoint ≥75-point IBS-SSS reduction at 90 days: 119 (40%) versus 57 (38%); absolute difference 1.9 percentage points (95% CI −8.1 to 12.0; p=0.76); 448 analysed of 450 enrolled. Adverse-event proportions similar; counts not in the abstract. Deep note: literature/notes/johnsen-2026-refit2.md. NCT04691544 was still active, not recruiting, enrolment 450, last update 2024-02-26, hasResults false. The registry was not marked completed.
  2. Wiki, demoted to draft. Microbiome (REFIT2 in the FMT table, the discordance paragraph, and the open question). Trials landscape (REFIT2 versus the registry lag; snapshot replaced; three status changes and the SIMBA status change). Epidemiology (Tohoku mortality, PMID 42702587, beside the existing NIH–AARP paragraph). Diagnosis (Wu 2026, PMID 42754968, as case-mix, not accuracy). Dietary therapy and red flags (Silva 2026, PMID 42712718). Red flags also records the paediatric cohort Li W 2026, PMID 42787978, and does not treat it as a replication of Miller 2004.
  3. Catalogue only. Shibli 2026, PMID 42066057, is document 33 in the guideline registry. The abstract names topics and a local algorithm and does not give grades. wiki/guidelines.md was not rewritten. NICE CG61, re-read 2026-09-30, was last reviewed 30 April 2025 and will not update the clinical-management section. The access date was updated. Date-restricted searches returned no Rome V guideline, no German S3 successor, and no Canadian IBS guideline.
  4. Questions. OQ-13 now records the negative phase 3. OQ-5 is sharpened and not closed. OQ-15 and D11 distinguish the adolescent cohort from the missing adult multi-tier replication. OQ-28 no longer says criteria-defined mortality follow-up was absent: the epidemiology page already had NIH–AARP, and Tohoku adds a Rome II community cohort. OQ-29 records the Chinese clinic's criteria yields. No OQ-31.

Registry status changes (no results posted). NCT05815602 ebastine versus mebeverine: recruiting → active, not recruiting (update 2026-09-11, n=200). NCT05643534 tenapanor, ages 12 to <18: active, not recruiting → completed (update 2026-09-22, n=180). NCT05721742 virtual dietitian: recruiting, n=76 → completed, n=71 (update 2026-09-09). NCT05633706 SIMBA capsule: recruiting → active, not recruiting (update 2026-09-30, n=300 total). Camlipixant (NCT07519395) and both brenipatide studies (NCT07545759, NCT07545772) were still recruiting (updates 2026-09-22). Condition total 1,173 (was 1,171). Recruiting 101 (was 111). The nine overall-status filters summed to 1,172. Phase filters are not a partition (phase 3 tag 106, was 105). query.intr: FODMAP 99 (was 97), vagus 11 (was 10); probiotic remains 133. The page's old "146 probiotic" sentence was an internal error and now says 133. Twenty-three records were updated since 2026-09-03. One new posting, NCT07829666 (completed diet comparison, n=90, first posted 2026-09-21), has no results and was not added to the intervention table. Results-first-post dates in the window: 0. The "21 phase 3 studies started since 1 January 2021" count was not re-counted.

Seen and not incorporated. PMID 42770627 (melatonin meta-analysis; quantitative pool four of seven trials). PMID 42790835 (IBS-like symptoms in quiescent IBD; out of scope). PMID 42782339 (fibre-blend pilot, n=26). PMID 42728685 (gels in healthy volunteers). PMID 42702764 (linaclotide age/menopause post hoc; effect similar across subgroups). PMID 42705700 (hypnotherapy commentary, no abstract). PMID 42712926 (uncontrolled FODMAP before-after). PMID 42751299 and PMID 42797624 (outbreak reports; the second was the only post-infectious-prevention hit and is not a prevention trial). PMID 42744599, PMID 42713162, PMID 42613193 (Rome V commentary, a "what is new" piece with no abstract, and a paediatric DGBI paper). PMID 42792799 (UK Biobank hypertension; the other mortality-gap hit). PMID 42766394 (ADHD stimulants, claims association). PMID 42704747 (lactose in functional dyspepsia). PMID 42793468 (qualitative study of 15 professionals). PMID 42741813 (acupuncture reproducibility). PMID 42792634 (narrative P2X3 review; the only camlipixant hit; no trial result). PMID 42694017 (social-media netnography; excluded under the existing no-social-media rule). PMID 42795257 (mebeverine versus otilonium cohort; adjusted analysis null). PMID 42727524 (EHR depression–GI directionality; the only neuromodulator hit, and not a trial). Fibre news in the window points at the already-cited Staudacher 2026 paper (PMID 42600900). GBD 2023 did not add an IBS-specific statistic worth a new row. Rome Foundation/IOIBD consensus PMID 42066865 is dated 2026-09-01, one day before the window, and is IBD-scoped. Date-restricted gaps that stayed empty: neuromodulator versus CBT, German and Canadian guidelines, Rome V guideline, statin/methanogen phase 3, criteria-stratified treatment, open-label placebo.

Patient organisations. Not updated. worldibsday.org and ibspatient.org returned HTTP 403. aboutibs.org and iffgd.org returned a browser check rather than page text. badgut.org, Guts UK, NHS and the Rome Foundation returned pages without a new IBS campaign statement worth adding. A Charity Commission request did not yield a verified successor for the removed IBS Network, and none is signposted.

Judgment calls. The search window used both publication date and Entrez date, so a record indexed after the audit was not missed only because its issue date was earlier. Melatonin was not given a bibliography line, because every line in that file has a citing page and the quantitative pool is four of seven trials. The Israeli paper is registry-only. IBD papers were left out under this condition's scope. INDEX was corrected, because it still said the audit had not happened, that every page was draft, and that there were 364 PMIDs and six notes. OQ-28 was corrected because it contradicted the epidemiology page even before Tohoku.

Next sweep should chase. REFIT2 full text, especially any ≥50-point or secondary analysis the abstract omits. Whether NCT04691544's registry status catches the Lancet paper. Readouts for camlipixant and brenipatide. Results, when posted, for ebastine versus mebeverine (now active, not recruiting), the completed paediatric tenapanor study, and the completed virtual-dietitian study. A Rome V society guideline. A German S3 successor and a Canadian IBS guideline. An adult multi-tier replication of Miller 2004. A primary-source check of any IBS Network successor before anyone is signposted there.

2026-09-02 — Independent audit (Codex; author: Claude)

Role and scope. Codex independently audited material authored by Claude. The audit covered all 20 files in wiki/ and all 13 artifacts in literature/: the bibliography, guideline registry, statistics sheet, six landmark notes and four patient-voice files. No shared roadmap or other condition was changed.

Live record checks. The final identifier set contained 378 unique PMIDs and 63 unique NCT identifiers (441 unique identifier records). Every PMID was re-fetched from PubMed E-utilities after the final edits; all 378 were returned as primary MedlineCitation/PMID records. Every NCT identifier was fetched separately from clinicaltrials.gov/api/v2/studies/<NCT> after the final edits; all 63 endpoints returned a record whose identificationModule.nctId exactly matched the requested identifier. The audit also checked 1,674 substantive claim–identifier pairs outside bibliography/reference lists: 1,589 claim–PMID pairs and 85 claim–NCT pairs across 32 content artifacts.

Searches re-run. A fresh ClinicalTrials.gov condition query returned 1,171 IBS records. Status and phase totals, recent phase 2/3 studies and intervention-specific counts were recalculated from that snapshot. Thirty-five targeted PubMed E-utilities searches were run to test negative assertions, including long-term dietary follow-up, mortality, consultation quality, sex-specific qualitative evidence, geographic coverage, criteria-stratified treatment, head-to-head therapies, long-term IBS-C efficacy, donor allocation in FMT, stigma interventions, response predictors, adult labelling replication, open-label placebo guidance and α2δ-ligand efficacy. Broad searches were narrowed when their Boolean scope admitted unrelated records. The three official NICE URLs and 17 unique patient-organisation/source URLs were also requested live.

Errors found and fixed. Every item below changed the audited material.

  1. Four invalid NICE PMIDs. PMIDs 21656972, 31825575, 32073807 and 33939353 did not resolve to the institutional NICE documents claimed. They were removed from the guideline page, guideline registry and bibliography. NICE CG61 and NG193 are now cited by their live official URLs, with publication/update/surveillance dates taken from the NICE pages.
  2. Bibliography incompleteness and generated count drift. Eight valid records already cited in the condition were absent from BIBLIOGRAPHY.md (PMIDs 11053260, 11570936, 15489576, 17488783, 21350320, 22489905, 29950604 and 37752291). They were added from live records. New evidence found during audit was also added, and all section labels were reconciled to their actual entry counts. The final bibliography contains 378 unique PubMed records plus two institutional NICE documents.
  3. Wrong first author. PMID 35183112 was attributed to Björkman; the live record identifies Frändemark as first author. The bibliography, annotated patient-voice source and thematic synthesis were corrected.
  4. Stale long-term low-FODMAP absence. The claim that controlled evidence did not extend beyond months was contradicted by a 12-month randomised follow-up (Tunali 2026, PMID 42623122). The diet page and statistics sheet now report 12-month response of 62.5% versus 34.5%, risk difference 28.0 percentage points (95% CI 4.2–47.7), while preserving the microbiome-specific limitation.
  5. Stale mortality absence. A search found an NIH–AARP cohort of 132,697 participants, including 5,030 with claims-identified IBS (Gutiérrez-Torres 2025, PMID 41518229). The epidemiology page and statistics sheet now report the time-varying estimates—HR 0.75 (95% CI 0.64–0.88) at >2–5 years and 0.92 (0.87–0.98) after >17 years—without interpreting the association as protective.
  6. Overbroad long-term IBS-C statement. The original “no trial beyond 26 weeks” wording ignored a 52-week lubiprostone safety study and a prospective 52-week linaclotide cohort (Yiannakou 2018, PMID 30302125). The page now distinguishes absence of placebo-controlled long-term efficacy from available open-label safety and observational effectiveness evidence; the linaclotide estimate is −70.7 IBS-SSS points (95% CI −95.0 to −46.5) among 76 paired observations.
  7. Stale sex-specific qualitative gap. Searches retrieved a gender-focused 19-interview study (PMID 24224642) and a work-life study with 15 women and 8 men (PMID 35183112). Patient-voice sources and themes now state that men's accounts are sparse rather than absent.
  8. Stale geographic qualitative gap. An Australian low-FODMAP qualitative study (PMID 42586418) and a Chinese social-media analysis (PMID 37093542) were retrieved. The eligible Australian study was incorporated. The Chinese study is recorded but excluded from synthesis under the existing no-social-media ethics rule. The residual geographic gap is scoped to regions not represented in the targeted search, rather than “non-Western evidence” generally.
  9. Overbroad patient-knowledge gap. A 2016–2017 study of 204 laypeople (Sherwin 2018, PMID 29319900) documented continuing misconceptions. The page now asks for a recent comparable national patient survey rather than claiming there was no later evidence at all.
  10. IBS Network status and link failure. The Charity Commission record now marks charity 1173208 as removed, and the historical domain serves unrelated commercial material. The organisation file now describes it as a former charity and explicitly warns against using the old site for signposting.
  11. Consultation-quality overstatement. POACHER (PMID 41922986) evaluates nurse-led structured investigation and management, not consultation quality in isolation. It is now presented as adjacent implementation evidence, while the narrower isolated-intervention gap is dated. Cross-trial claims that consultation effects were “comparable to” or exceeded drug effects were removed.
  12. Missed α2δ-ligand efficacy trial. The neuromodulator page said no efficacy trial followed the 2007 pregabalin mechanism study. A 330-participant randomised trial of the related ligand PD-217,014 found no benefit at either dose or in Rome II/IV bowel-habit subgroups (Houghton 2025, PMID 39812493). That negative class-level result is now included while retaining the narrower finding that pregabalin itself lacks a retrieved symptom-efficacy trial.
  13. Clinical-trial search/count methodology. Intervention totals described as registry “mentions” were not reproducible as condition-plus-intervention API counts. The page and statistics sheet now state the query method and the reproducible counts: probiotic 133, FODMAP 97, CBT 50, FMT 37, linaclotide 27, rifaximin 26, hypnotherapy 22, acupuncture 18, vagus 10, tenapanor 9, amitriptyline 4 and ebastine 4.
  14. Pipeline omissions and exclusivity claim. The live registry contained two recruiting Lilly phase 2 brenipatide studies omitted from the landscape (NCT07545759, planned n=531 in IBS-D; NCT07545772, planned n=342 in IBS-C) and an active phase 2 psilocybin-plus-psychotherapy study (NCT06206265). These were added. Wording implying camlipixant was the sole large current novel programme was removed.
  15. Multi-condition enrolment overstatement. NCT04014413 reports n=450 for a multi-condition FMT platform, not an IBS-only cohort, and NCT05633706 reports n=300 across seven conditions plus controls, not 300 participants with IBS. Both rows now label total-study enrolment and the absence of an IBS subgroup target.
  16. Undated permanent absences. Negative assertions about criteria stratification, cluster-based allocation, barostat-guided allocation, combined mechanism algorithms, missed microscopic-colitis outcomes, post-infectious prevention, head-to-head neuromodulator/behavioural therapy, secretagogue comparisons, response predictors, long-term antispasmodic efficacy, adult label replication, stigma intervention and open-label placebo guidance were rewritten as positively stated, dated search findings with their scope.
  17. Comparative-efficacy overstatement. Claims that psychological therapy was the “largest” treatment effect and that consultation quality was quantitatively comparable with licensed drugs relied on indirect cross-trial comparisons. They were replaced with within-study estimates and explicit warnings that heterogeneous populations, controls and endpoints prevent direct ranking.
  18. Guideline reference numbering. Removing the invalid NICE PMIDs left a four-number gap in the guideline reference list. The list was renumbered consecutively without changing the remaining records.

Internal consistency checks. Every PMID used in a wiki page or literature artifact is present exactly once in the bibliography's unique record set. Every PMID used in the body of a wiki page appears in that page's reference section. Live-record first-author checks found no remaining mismatch after correcting PMID 35183112. Bibliography section labels equal their actual entry counts. No [unverified], TODO, TBD, placeholder or unresolved identifier remains in wiki/ or literature/.

Remaining provenance limitations. Automated retrieval still receives HTTP 403 from IFFGD, About IBS and badgut.org. Their entries remain explicitly described as based on search-result excerpts rather than direct page text and are not used for numerical claims. The historical IBS Network site remains unsafe for signposting. These are access/provenance limitations, not unresolved PMID/NCT or substantive evidence claims.

Promotion result. 20/20 wiki pages promoted from draft to curated; 0 remain draft. Promotion occurred only after the final 378-PMID and 63-NCT live resolution passes and the claim/reference consistency checks above.

2026-09-02 — Full build (Claude)

What was built. All twenty planned wiki pages, the complete literature layer, a rewritten OPEN-QUESTIONS.md and an updated INDEX.md. The condition moves from seeded to built. No page was promoted beyond status: draft; the auditor must be a different engine.

Totals. 20 wiki pages, ~3,000 lines; 364 unique PMIDs, every one resolved live from PubMed E-utilities during this session; 38 NCT identifiers, every one retrieved live from the ClinicalTrials.gov v2 API on 2026-09-02; 6 landmark notes; a 32-document guideline registry; a ~250-row statistics sheet; a four-file patient-voice layer; 30 open questions (OQ-1 to OQ-30) and 12 dots-not-yet-connected.

Anchor re-verification. All twelve anchor records from the seed session were re-fetched and confirmed (author, year, journal, volume, pages): PMIDs 32294476, 32702295, 33315591, 29950604, 37858323, 39397570, 30177784, 40258375, 31859183, 38643782, 28846594, 21208106. None was wrong.

Gaps the seed flagged, and how they were closed. - Rome IV primary document — Drossman 2016 (PMID 27144617) and Palsson 2016 (PMID 27144634). Plus an unanticipated finding: Rome V was published in May 2026 (Drossman 2026, PMID 42031435), with a global epidemiology survey (Sperber 2026, PMID 42613194) and a first diagnostic-accuracy study (Staller 2026, PMID 42392123). This substantially changed the diagnosis and epidemiology pages and is the single most important thing the seed could not have known. - BSG/AGA/NICE guidelines — closed, plus JSGE, Seoul Consensus 2025, Italian joint consensus, UEG/ESNM, APAGE, Asian Consensus, AMG Mexico, WGO, German S3, BDA, ESPGHAN/NASPGHAN: 32 documents in the registry. - Gut-directed hypnotherapy trials — closed (Lövdahl 2022, PMID 35505463; Lövdahl 2025 two-year follow-up, PMID 40491242; Berry 2023 digital, PMID 37391055; Devenney 2024, PMID 37927144). - Linaclotide and tenapanor registrational trials — closed (Chey 2012, PMID 22986437; Chey 2021, PMID 33337659; plus plecanatide, lubiprostone, MD-7246). - Eluxadoline pancreatitis safety — closed (Cash 2017, PMID 27922029; Gawron 2018, PMID 28804032). - Open-label placebo trials — closed (Kaptchuk 2010, PMID 21203519; Lembo 2021, PMID 33605656; Nurko 2022, PMID 35099543; Ballou 2022 predictors, PMID 35412513). - Post-infectious IBS cohorts — closed (Walkerton series, Klem 2017, Porcari 2024, Svendsen 2019, Zanini 2012, Hanevik 2014, Villani 2010 genetics, Dunlop 2003 prednisolone). - Bile acid diarrhoea diagnostics — closed (Slattery 2015, Wedlake 2009, Valentin 2016, Dilmaghani 2025 sequestrants). - Patient-organisation material — closed by direct web retrieval, with failures recorded (see below).

Searches run (live PubMed E-utilities, 2026-09-02). Approximately 120 distinct queries across: Rome criteria and their validation; subtyping, Bristol stool scale and latent-class analysis; prevalence by region and criteria; sex differences; cost of illness; work productivity; coeliac, calprotectin, colonoscopy yield, microscopic colitis, bile acid diarrhoea, exocrine pancreatic insufficiency, giardiasis, lactose, ovarian cancer misdiagnosis, alarm features; visceral hypersensitivity and barostat methodology; brain imaging; mast cells, ebastine, nerve-fibre outgrowth; enterochromaffin cells and the female sex bias; GWAS and Mendelian randomisation; early-life adversity; microbiome composition, SCFAs, methanogens and hydrogen sulphide, probiotics by strain, FMT; post-infectious incidence by pathogen and its genetics and mucosal biology; anti-CdtB/anti-vinculin; low FODMAP and its comparators, reintroduction, fibre, gluten and wheat; peppermint oil and antispasmodics including mechanism and the labelling trial; every licensed IBS-C and IBS-D drug plus tegaserod's regulatory history; rifaximin, neomycin, SIBO prevalence and breath-test thresholds and their conflict-of-interest dispute; neuromodulators agent by agent; behavioural therapy networks, delivery modality, mindfulness and physical activity; placebo and nocebo magnitude, components, open-label placebo, endpoints and IBS-SSS; functional dyspepsia overlap, GORD overlap, central-sensitisation comorbidity, the duodenal hypothesis; guidelines worldwide; stigma, invalidation, patient educational needs, suicidality. ClinicalTrials.gov v2 API: total and status/phase breakdowns, recruiting studies, phase 2/3 studies started 2021 or later, and targeted queries for digital therapeutics, hypnotherapy, CBT, FMT, probiotics, FODMAP, rifaximin, linaclotide, tenapanor, amitriptyline, ebastine, acupuncture and vagus-nerve stimulation.

Query-hygiene note. The seed's caution about unparenthesised boolean OR was carried forward; all multi-term queries this session were parenthesised or issued as single phrases, and counts quoted in pages are stated with their retrieval date.

Findings that changed the shape of the build. 1. Rome V exists. Published May 2026, with global prevalence at 8.5% and DGBI overall unchanged from Rome IV (40.9% vs 40.5%), but only fair-to-moderate agreement with either predecessor (κ 0.36–0.55) and sensitivity of 66.1% — below Rome III and Rome IV — in its first accuracy study. Every guideline in the registry predates it. 2. Diet beats drugs in two independent randomised trials. CARIBS (specialist clinic, versus optimised medical treatment) and DOMINO (primary care, versus otilonium bromide, using a smartphone app). DOMINO was not in the seed anchor set and was found during the build. 3. A randomised 2×2 factorial trial separates drug from label. Mebeverine itself did nothing; the label "mebeverine" nearly doubled treatment success (OR 2.84, 1.52–5.34). This reframes the older antispasmodic meta-analyses and is now cited on three pages. 4. Eluxadoline's post-marketing pancreatitis signal is larger than the trial data suggest — 16.4% of 597 adverse-event reports, 53 hospitalisations, two reported fatalities. 5. The blinded FODMAP reintroduction control triggers symptoms in 26% of exposures, quantifying the nocebo share of dietary trigger identification. 6. Only 3% of rural primary-care patients with IBS report IBS alone without a comorbid central-sensitisation condition.

Contradictions recorded rather than resolved (all presented side by side with both sources): Rome IV prevalence lower than Rome III in three syntheses and higher in one; FMT effective in one large trial and null in two, with meta-analyses disagreeing on whether an effect exists; Escherichia probiotic strains rated highest-certainty benefit by one 2023 synthesis and ineffective by a 2026 strain-specific one; coeliac screening in IBS supported by one 2025 meta-analysis and questioned for North America by a 2017 one; SSRIs recommended against by AGA and found modestly effective by the 2025 meta-analysis; quality of life comparable to stroke by EQ-5D and better than rheumatoid arthritis by SF-36; peppermint oil ranked first in a network meta-analysis and failing both co-primary endpoints in its best single trial; breath-test SIBO in 35.5% of patients and 29.7% of controls.

Absences searched and dated (2026-09-02). No prevention trial in post-infectious IBS using the validated risk score; no head-to-head neuromodulator-versus-behavioural-therapy trial; no criteria-stratified treatment analysis; no cohort quantifying incident eating-disorder diagnoses after low-FODMAP instruction; no population mortality follow-up in criteria-defined IBS; no replication of the 2004 multi-tier suicidality survey; no four-arm open-label-placebo drug trial; no German S3 successor guideline; no Canadian IBS guideline; no phase 3 result for statin-based methanogen inhibition. Each of these is stated in the pages as a dated absence, not as a permanent fact — re-run before repeating.

Patient-voice layer: retrieval outcomes recorded honestly. Seven organisational URLs were retrieved successfully (Guts UK, IBS Patient Support Group, World IBS Day, MAGDA, PDS Belangenorganisatie, Rome Foundation, NHS). Three returned HTTP 403 to automated retrieval (IFFGD, aboutibs.org, badgut.org) and are described from search-result excerpts of the organisations' own pages, flagged as such. One finding is recorded deliberately: theibsnetwork.org resolved on 2026-09-02 to a cryptocurrency-casino review site, not to the UK IBS charity. The charity is independently verified as registered (Charity Commission 1173208) but its current live web address was not established this session and must be re-verified before the entry is used to signpost anyone.

Ethics. The patient-voice layer used public sources only; no social media, forums or individual stories; paraphrase by default with quotations capped at 15 words and attributed; no private individuals named (the single named person, Jeffrey Roberts, is a public organisational founder named on his organisation's own page); themes reported in aggregate with sample sizes given.

Judgement calls made during the build (recorded because no question could be asked mid-session): - Functional dyspepsia was written as an overlap page only, per the brief. Its own mechanism, subtypes and treatments are deliberately not curated. - Paediatric evidence was cited where it is the only or the decisive evidence (the mebeverine labelling trial, the open-label placebo trial in children, paediatric guideline documents) and explicitly flagged as paediatric each time; this knowledge base is adult-scoped. - Two adjacent guidelines (NICE chronic primary pain; ACG SIBO) were included in the registry as "adjacent" because they materially govern IBS practice. - The clinical-trials page carries fewer PMIDs than other pages because its primary evidence is the trial registry itself; 38 NCT identifiers are listed and dated instead. - Cross-condition links were made to anorexia nervosa, fibromyalgia, depression, generalized anxiety disorder, migraine and PTSD, all of which exist in this repository.

Not verified / flagged for the auditor. - The three organisation entries resting on search-result excerpts rather than direct retrieval (IFFGD, About IBS, badgut.org) should be re-tested; if retrieval succeeds, the entries should be upgraded. - The IBS Network's current URL is unresolved and must be established before use. - Two citation details were deliberately left partial rather than completed from inference: Ju 2024 (PMID 38892659) and Ng 2023 (PMID 37110143) are cited with volume only, because issue and page numbers were not present in the retrieved records. - The Kruis 1984 sensitivity/specificity pairs in STATISTICS.md are two operating points from one weighted score, not two independent estimates; this is annotated in the file's caveats section. - Several 2026 records are "online ahead of print" and carry no final volume/pages; they are cited with the retrieval note rather than an invented citation string. - The seed's per-page PubMed topic counts were not reused, because the exact query strings behind them were not recorded. Where a sub-literature size is quoted in a page, the query string is printed alongside the count and the date and was run in this session (e.g. irritable bowel syndrome AND (microbiome OR microbiota) = 2,797 on 2026-09-02, replacing the seed's 1,613). The two scoping counts in the seed (21,184 and 9,618) were re-run and confirmed unchanged.

Follow-ups for the next session. 1. Audit — a different engine must re-fetch every cited record, check each claim against it, re-run the searches behind every asserted absence, and only then promote pages to curated. The log entry must name both engines. 2. Re-test every URL in literature/patient-voice/sources.md section C before the layer is used for signposting. 3. Watch for guideline revisions incorporating Rome V, and for the camlipixant (NCT07519395) and Norwegian FMT (NCT04691544) readouts. 4. Consider whether functional dyspepsia warrants its own condition once IBS is audited; the overlap page currently carries more of its mechanism than a pure overlap page should. 5. CONDITIONS-ROADMAP.md was not modified this session, per the build brief (a concurrent agent may be editing it); its status entry for this condition needs updating to built by whoever owns that file.

2026-09-02 — Seeded (Claude)

Created the scaffold: INDEX.md with a 20-page plan (18 topical + 2 standing house pages) and a 12-record anchor table, a seed OPEN-QUESTIONS.md, this log, and the empty wiki/ and literature/ layers. No wiki pages written.

Searches run (live PubMed E-utilities, 2026-09-02). Scoping: irritable bowel syndrome 21,184; irritable bowel syndrome[MeSH Major Topic] 9,618. Per-page topic counts in INDEX.md, including epidemiology 3,607, microbiome 1,613, placebo response 813, low FODMAP 684, constipation pharmacotherapy 557, Rome IV 533, D-IBS pharmacotherapy 371, neuromodulators 337, visceral hypersensitivity 336, post-infectious 319, functional dyspepsia overlap 259, psychological therapy 112, bile acid malabsorption 113, rifaximin/SIBO 65, stigma 34.

Query-hygiene note. Two initial queries were malformed by unparenthesised OR (eluxadoline OR loperamide diarrhea returned 1,223 rather than 371). Re-run parenthesised and marked † in INDEX.md.

Anchor records resolved live: 12, listed in INDEX.md.

Scoping decisions. First curated condition in the digestive category, and the page list deliberately departs from the drug-centred house shape: diet, psychological therapy and the diagnostic label itself carry as much weight as pharmacotherapy, because that is where the evidence is. Borders: the condition owns IBS and not disorders of gut–brain interaction generally, with functional dyspepsia framed as overlap; organic disease (IBD, coeliac, microscopic colitis, bile acid diarrhoea) appears only as differential, scoped to how it is excluded and how often it is missed. IBD is not curated in this repository and must not be quietly built here.

The placebo response is scoped as a page, not a caveat. In a condition diagnosed by symptom report and treated for symptom relief, the magnitude and mechanism of the placebo response — including open-label placebo trials — is substantive evidence about the condition rather than a footnote on trial design. 813 records support it.

Flagged for the build pass. No anchor yet for the Rome IV primary document, BSG/AGA/NICE guidelines, gut-directed hypnotherapy, linaclotide and tenapanor registrational trials, eluxadoline pancreatitis safety reports, open-label placebo trials, or patient-organisation material.

Follow-ups. Build with tools/build-condition.sh irritable-bowel-syndrome; auditor must differ from the writer.