Mistakes in irritable bowel syndrome and how to avoid them

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Mistakes in irritable bowel syndrome and how to avoid them

Robin Spiller

Summary

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This material addresses common mistakes in the diagnosis and management of irritable bowel syndrome, a heterogeneous condition affecting 11% of the global population with varied bowel habit presentations.

IBS affects approximately 11% of the worldwide population, making it one of the most frequent gastroenterological diagnoses.
All IBS patients experience recurrent abdominal pain, but bowel habits vary: around one-third have predominantly diarrhoea (IBS-D), one-fifth have predominantly constipation (IBS-C), and half have a mixed pattern (IBS-M).
The author states that IBS has multiple causes and requires an individualized approach to management and treatment.
The material is intended to review frequent mistakes in IBS diagnosis and management, based on published data and clinical experience.

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Abstract

Around 11% of the worldwide population experience irritable bowel syndrome (IBS), making it one of the most frequent gastroenterological diagnoses.1 The symptoms of IBS include abdominal pain associated with unpredictable bowel habits and variable changes in the form and frequency of stool.2 While all patients with IBS suffer from recurrent bouts of abdominal pain, their bowel habits are varied: around one-third suffer predominantly with diarrhoea (IBS-D), one-fifth experience predominantly constipation (IBS-C) and half have an erratic mixed pattern of both diarrhoea and constipation (IBS-M).3 This very heterogeneous condition undoubtedly has multiple causes and an individualized approach to management and treatment is required. Here I discuss the mistakes most frequently made when diagnosing and managing IBS. The mistakes and discussion that follow are based, where possible, on published data and failing that on many years of my own clinical experience.

Topics

Neurogastroenterology & Motility Primary Care

Citation

Spiller R. Mistakes in irritable bowel syndrome and how to avoid them. UEG Education 2016: 16; 31–33.

Published

2024

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European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management

Carolina Malagelada

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UEG Standards and Guidelines

Consensus

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European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management

Carolina Malagelada

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Guideline

ABSTRACT

Introduction

Chronic nausea and vomiting are symptoms of a wide range of gastrointestinal and non-gastrointestinal conditions. Diagnosis can be challenging and requires a systematic and well-structured approach. If the initial investigation for structural, toxic and metabolic disorders is negative, digestive motility and gut-brain interaction disorders should be assessed. United European Gastroenterology (UEG) and the European Society for Neurogastroenterology and Motility (ESNM) identified the need for an updated, evidence-based clinical guideline for the management of chronic nausea and vomiting.

Methods

A multidisciplinary team of experts in the field, including European specialists and national societies, participated in the development of the guideline. Relevant questions were addressed through a literature review and statements were developed and voted on according to a Delphi process.

Results

Ninety-eight statements were identified and voted following the Delphi process. Overall agreement was high, although the grade of scientific evidence was low in many areas. Disagreement was more evident for some pharmacological treatment options. A diagnostic algorithm was developed, focussing on the differentiating features between gastrointestinal motility and gut-brain interaction disorders with predominant nausea and vomiting.

Conclusion

These guidelines provide an evidence-based framework for the evaluation and treatment of patients with chronic nausea and vomiting.

Publisher

European Society of Neurogastroenterology and Motility

Guideline

Consensus

Topics

Neurogastroenterology & Motility Paediatrics Primary Care Stomach & H. Pylori

Citation

United European Gastroenterol J.

Published

2025

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UEG Mistakes In Articles

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Mistakes in the use of PPIs and how to avoid them

Albert J. Bredenoord, Roos E. Pouw

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Abstract

Proton pump inhibitors (PPIs), first introduced with omeprazole in 1988, revolutionized the treatment of gastric acid-related conditions like gastro-oesophageal reflux disease, gastroduodenal ulcers, and Helicobacter pylori infections. Despite their effectiveness, PPIs are often prescribed for conditions without a proven link to gastric acid, such as dyspepsia and upper abdominal discomfort. Long-term use of PPIs has raised safety concerns, including risks of vitamin and mineral malabsorption, pneumonia, gastrointestinal infections, and dementia. This Mistakes In article addresses nine common mistakes in PPI use and aims to clarify misconceptions about their use.

Topics

Digestive Oncology Oesophagus

Citation

Pouw R.E. and Bredenoord A.J. Mistakes in the use of PPIs and how to avoid them. UEG Education 2017; 17: 15–17.

Published

2024

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UEG Podcast Episode

UEG Podcast

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MASLD with Sven Francque - Part 2

Sven Francque, Pradeep Mundre

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Abstract

Topics

Hepatobiliary

Published

2026

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European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management

Carolina Malagelada

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Mistakes in eosinophilic oesophagitis and how to avoid them

Alfredo J. Lucendo

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UEG Mistakes In Articles

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Mistakes in eosinophilic oesophagitis and how to avoid them

Alfredo J. Lucendo, Javier Molina-Infante

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Abstract

Eosinophilic oesophagitis (EoE) is a chronic immune-mediated inflammatory condition that is confined to the oesophagus. Clinically, EoE is characterized by symptoms of oesophageal dysfunction; histologically, by eosinophil-predominant inflammation.1,2 At present, EoE is the second-most frequent cause of chronic oesophagitis (gastro-oesophageal reflux disease [GORD] is the primary cause) and the foremost cause of dysphagia and food impaction in young adults and children.

Topics

Oesophagus

Citation

Molina-Infante J and Lucendo AJ. Mistakes in eosinophilic oesophagitis and how to avoid them. UEG Education 2017: 17; 6–9.

Published

2024

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European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management

Carolina Malagelada

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Albert J. Bredenoord

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Mistakes in eosinophilic oesophagitis and how to avoid them

Alfredo J. Lucendo

Mistakes in jejunal feeding and how to avoid them

Ashley Bond

Mistakes in Familial Mediterranean Fever and how to avoid them

Gagik Hakobyan

UEG Mistakes In Articles

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Mistakes in jejunal feeding and how to avoid them

Ashley Bond, Simon Lal

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Abstract

Topics

Small Intestine & Nutrition

Citation

Bond A and Lal S. Mistakes in jejunal feeding and how to avoid them. UEG Education 2020; 20: 17–19.

Published

2020

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European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management

Carolina Malagelada

Mistakes in the use of PPIs and how to avoid them

Albert J. Bredenoord

MASLD with Sven Francque - Part 2

Pradeep Mundre

Mistakes in eosinophilic oesophagitis and how to avoid them

Alfredo J. Lucendo

Mistakes in jejunal feeding and how to avoid them

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UEG Mistakes In Articles

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

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Mistakes in Familial Mediterranean Fever and how to avoid them

Manik Gemilyan, Gagik Hakobyan

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Abstract

Familial Mediterranean fever (FMF), also called periodic disease, Armenian disease, etc., is a prototypical autoinflammatory disorder where the underlying mechanism is the dysfunction of innate immunity, resulting in unprovoked episodes of inflammation.¹ Although considered rare worldwide, it is prevalent in people of Mediterranean origin; however, one can expect to encounter patients in all parts of the modern world. FMF is a monogenic disease with autosomal recessive inheritance.² Unlike other monogenic disorders, the diagnosis remains largely clinical, and it is important to understand the limitations of genetic testing. Another distinguishing feature is the well-established effectiveness of lifelong monotherapy with colchicine in preventing attacks and complications.³

Topics

Primary Care

Published

2025

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European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management

Carolina Malagelada

Mistakes in the use of PPIs and how to avoid them

Albert J. Bredenoord

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Pradeep Mundre

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