PATIENT PRESENTATION MARKER

IBS symptoms

What this marker measures

The degree to which Rome IV criteria are met/not met for irritable bowel syndrome. This does not constitute a diagnosis.

Health categories/Interpretations informed by this marker

Gut-brain axis
● Visceral hypersensitivity: around 60% of IBS patients demonstrate visceral hypersensitivity.^1,2● Abdominal pain link: irritable bowel syndrome is characterised by abdominal pain.
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Clinical features
‍● Lower GI symptoms: IBS symptoms are a commonly-reported lower GI symptom cluster that can affect quality of life.
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Interpreting the result

PRESENT

Questionnaire responses indicate abdominal pain on 1 or more days per week, for 6 months or more, with two or more of: pain affected by bowel motions; a change in stool appearance or consistency with pain; pain linked to bowel motion frequency. Meets Rome IV criteria for IBS.

PARTIALLY PRESENT

Questionnaire responses indicate abdominal pain on 1 or more days per week, for less than 6 months, with two or more of: pain affected by bowel motions; a change in stool appearance or consistency with pain; pain linked to bowel motion frequency.

NOT PRESENT

Questionnaire responses do not meet the criteria for Present or Partially present.

Patient management insights

CLINICAL MANAGEMENT

Trial gut-directed hypnotherapy: gut-directed hypnotherapy may improve IBS symptom severity.^9,10
GRADE C

DIETARY STRATEGIES

Add ground flaxseed: ground or whole flaxseed may improve IBS severity.³
GRADE D

Add psyllium husk: psyllium husk may improve IBS symptom severity.⁴
GRADE D

CLINICAL MANAGEMENT

Take peppermint oil: enteric-coated peppermint oil may improve abdominal pain, sensation of incomplete emptying, pain with evacuation, faecal urgency and help normalise stool frequency in IBS.^5–7
GRADE C

Take alpha-galactosidase enzyme: supplementation with the enzyme α-galactosidase during meals may reduce overall IBS symptoms in GOS-sensitive IBS patients.⁸
GRADE C

Tips for patients discussion

"Your questionnaire responses show a pattern of tummy pain linked to your bowel habits. These symptoms are common and can affect how you feel day to day. There are several options we can try, from fibre and peppermint oil to gut-directed hypnotherapy, and we'll start with the one that best suits your situation."

Source references for all clinical associations, interpretation definitions, and patient management insights on this card.

1. Mujagic, Z. et al. Biomarkers for visceral hypersensitivity in patients with irritable bowel syndrome. Neurogastroenterol Motil 29, e13137 (2017).
2. Roberts, C. et al. Factors influencing rectal hypersensitivity in irritable bowel syndrome: a systematic review and meta-analysis. Neurogastroenterol Motil 35, e14515 (2023).
3. Cockerell, K. M. et al. Effects of linseeds on the symptoms of irritable bowel syndrome: a pilot randomised controlled trial. J Hum Nutr Diet 25, 435–443 (2012).
4. Bijkerk, C. J. et al. Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial. BMJ 339, b3154 (2009).
5. Cappello, G. et al. Peppermint oil (Mintoil) in the treatment of irritable bowel syndrome: a prospective double blind placebo-controlled randomized trial. Dig Liver Dis 39, 530–536 (2007).
6. Liu, J.-H. et al. Enteric-coated peppermint-oil capsules in the treatment of irritable bowel syndrome: a prospective, randomized trial. J Gastroenterol 32, 765–768 (1997).
7. Cash, B. D., Epstein, M. S. & Shah, S. M. A novel delivery system of peppermint oil is an effective therapy for irritable bowel syndrome symptoms. Dig Dis Sci 61, 560–571 (2016).
8. Tuck, C. J. et al. Increasing symptoms in irritable bowel symptoms with ingestion of galacto-oligosaccharides are mitigated by α-galactosidase treatment. Am J Gastroenterol (2017). doi:10.1038/ajg.2017.245
9. Anderson, E. J., Peters, S. L., Gibson, P. R. & Halmos, E. P. Comparison of digitally delivered gut-directed hypnotherapy program with an active control for irritable bowel syndrome. Am J Gastroenterol 120, 440–448 (2025).
10. Lövdahl, J. et al. Nurse-administered gut-directed hypnotherapy for irritable bowel syndrome: a two-year follow-up study. United European Gastroenterol J 13, 1307–1317 (2025).