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Chandigarh, April 27: Irritable bowel syndrome (IBS) is the most frequent functional gastrointestinal (GI) disorder. It affects 5-20% of the general population. It is characterized by non-specific symptoms of pain in the abdomen, abdominal cramps, change in bowel habits, that wax and wane over the time and can have serious impact on quality of life. Dr. GS Sidhu, Principal Consultant Gastroenterology at Max Super Specialty Hospital, Mohali said that careful study of patient medical history is critical for its diagnosis. Nevertheless, severity of patient symptoms sometimes compels physicians to perform expensive diagnostic tests, transforming IBS into diagnosis of exclusion. He further said,” The presence of alarming symptoms like fever, weight loss, rectal bleeding, presence of palpable mass, age more than 50 years, family history of colorectal carcinoma, IBD, celiac disease all warrant investigation. Absence of visible signs, lack of awareness of disease and poor explanation of disease by clinician to patient keeps disease undiagnosed for a long time in most patients,” Talking about why IBS can go undiagnosed, Dr. GS Sidhu informed that most of the time symptoms of IBS like cramps, abdominal discomfort, bloating, alternate diarrhoea or constipation etc. remain nonspecific. This may change over an interval of time and most importantly no visible signs of disease. Another reason in clinical practice is that most of the time, the nature of disease is not explained to the patient by the clinician.” Talking about the causes behind IBS, Dr. GS Sidhu said that the pathophysiology of IBS is not yet completely clear. Genetic, immune, environmental, inflammatory, psychological factors in addition to visceral hypersensitivity can all play an important role, one that most likely involves the complex interactions between gut and brain (gut- brain axis). Diagnosis can be made on the basis of symptoms only, he said. “It's disruption of the brain gut axis that alters bowel motility and gut function. In addition intestinal microbiota could play a role by altering integrity of intestinal barrier and permeability. 33% of IBS patients have family history of IBS,” Previously the IBS was also being called as spastic colon. In recent years it has been observed that ingestion of wheat may cause abdominal discomfort and IBS-like symptoms in subjects without diagnosis of celiac disease. So careful history is critical for making diagnosis of IBS, maintained Dr. GS Sidhu.