Irritable bowel syndrome: not ‘just nerves’, but a diagnosis

Elena Kasimtseva — GP, gastroenterologist, Medical Director of GMS Clinic

IBS is the most common cause of chronic abdominal discomfort and, at the same time, the most dismissed diagnosis: patients are often told that "everything is fine, it is just nerves". In fact, it is a condition with defined criteria and treatment that works.

How the diagnosis is made

Contrary to popular belief, IBS is not a diagnosis of exclusion, given when nothing else has been found. It is a disorder of gut–brain interaction, and the Rome criteria exist to diagnose it.

Under the updated Rome V criteria, what counts is recurrent abdominal pain or discomfort on average at least three days a month over the last three months, associated with at least two of the following: defecation, a change in stool frequency or a change in stool form. Symptoms must have started at least six months ago.

With a typical picture and no red flags, the diagnosis is made clinically, using a limited set of investigations, rather than by endlessly ruling out every possible disease.

Which tests make sense

A sensible minimum rather than "check everything": a full blood count and, for the diarrhoea type, coeliac screening, C-reactive protein and faecal calprotectin to rule out inflammatory bowel disease.

At GMS faecal calprotectin is AED 350, the coeliac disease profile from AED 450 and a full blood count AED 100.

Additional investigations are not ordered for everyone, only when there are relevant symptoms, risk factors or abnormalities in the basic tests. Routine colonoscopy, tests for gut infections and extended "check-ups" are usually not needed with a typical IBS picture and no red flags.

Red flags

• new symptoms at an older age, especially after 50;
• blood in the stool;
• unexplained weight loss;
• iron deficiency anaemia;
• night-time symptoms that regularly wake you up;
• fever or persistent severe diarrhoea;
• bowel cancer, inflammatory bowel disease or coeliac disease in close relatives.

Any of these changes the approach: in this situation the extent of investigation is decided individually and may include endoscopic and other investigations.

What helps

The first step is regular meals and individual adjustment of the diet. A diet that restricts fermentable carbohydrates — low FODMAP — is one of the most studied dietary approaches in IBS and may be offered to patients for whom basic advice has not been effective enough.

Importantly, it is not a lifelong regime but a three-phase protocol: restriction for 2–6 weeks, then gradual reintroduction of foods to identify individual triggers and build as varied a diet as possible.

This protocol is best followed under the supervision of a doctor or dietitian familiar with low FODMAP. Long-term restriction on your own can lead to an unbalanced diet and needlessly cutting out a large number of foods.

In some types of IBS, soluble fibre such as psyllium helps. Fibre should be increased gradually, as a sharp increase can make bloating worse.

Next comes symptomatic treatment tailored to the type of IBS, regular physical activity, better sleep and managing stress. Cognitive behavioural therapy and other psychological approaches targeting gut–brain interaction have proven effectiveness and are included in guidelines alongside medication.

The link between the gut and the nervous system is real and works both ways. This does not mean the symptoms "exist only in your head"; it explains why effective IBS treatment often combines diet, medication and approaches that act on the gut–brain axis.

Where to get it sorted out

At GMS a gastroenterologist consultation is AED 750, tests are done at the same clinic, and we discuss the results at the appointment. Consultations in Russian and English.

Clinical guidelines

• American College of Gastroenterology. Management of Irritable Bowel Syndrome
• Rome Foundation. Rome V Criteria

FAQ

Which tests do I need for irritable bowel syndrome?

A sensible minimum: a full blood count (AED 100) and, for the diarrhoea type, coeliac screening (from AED 450), C-reactive protein and faecal calprotectin (AED 350) to rule out inflammatory bowel disease. Routine colonoscopy, tests for gut infections and extended check-ups are usually not needed without red flags.

What is the low FODMAP diet and is it for life?

It restricts fermentable carbohydrates and is one of the most studied dietary approaches in IBS, offered when basic advice is not enough. It is not lifelong but a three-phase protocol: restriction for 2–6 weeks, then gradual reintroduction of foods to identify triggers. Best followed under a doctor or dietitian familiar with it.

When do IBS symptoms need further investigation?

With red flags: new symptoms after 50, blood in the stool, unexplained weight loss, iron deficiency anaemia, night-time symptoms that wake you, fever or persistent severe diarrhoea, or bowel cancer, inflammatory bowel disease or coeliac disease in close relatives. The extent of investigation is then decided individually and may include endoscopy.

This article is for information only and does not replace a consultation. If you have symptoms, see a doctor.

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