Wellness Goals · Digestive condition

Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (a disorder of gut-brain interaction) · also called IBS, irritable bowel, IBS-C, IBS-D, IBS-M, síndrome del intestino irritable

Irritable bowel syndrome (IBS) is a group of symptoms that occur together: repeated belly pain and changes in bowel movements, with no visible damage to the digestive tract. It differs from inflammatory bowel disease (IBD) and celiac disease, and doctors mostly diagnose it from the symptom pattern after ruling out other causes. Guidelines suggest a limited low-FODMAP diet trial and gut-directed psychotherapy. Fiber, probiotics and peppermint oil have modest or uncertain evidence. See a doctor for blood in the stool, weight loss or symptoms that change.

General information, not medical advice. Last substantive update October 31, 2026 · Not medically reviewed. A named clinician has not signed off on this page. How this page is made

About Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) is a long-lasting group of symptoms: belly pain with changes in bowel movements, and no visible damage to the digestive tract. It differs from inflammatory bowel disease (IBD) and celiac disease, which need their own tests. IBS is diagnosed mainly from the symptom pattern after other causes are ruled out. Guidelines suggest a limited low-FODMAP diet trial and gut-directed psychotherapy, while fiber, probiotics and peppermint oil have modest or uncertain evidence. See a doctor for blood in the stool, weight loss or changing symptoms.

What irritable bowel syndrome (IBS) is

NIDDK describes irritable bowel syndrome (IBS) as a group of symptoms that occur together: recurring belly pain and changes in bowel movements, which may be diarrhoea, constipation or both, with no visible sign of damage or disease in the digestive tract. About 12 percent of people in the United States have IBS, women are up to twice as likely as men to develop it, and it is more common in people under 50.

Three types are described by stool pattern: IBS with constipation (IBS-C), with diarrhoea (IBS-D) and with mixed bowel habits (IBS-M). The 2021 British guideline classes IBS as a disorder of gut-brain interaction. NIDDK says IBS is long-lasting but symptoms come and go, and it does not damage the digestive tract.

^{24 27 17}

Symptoms and what can set them off

Common symptoms are belly pain or cramps often eased by a bowel movement, bloating, diarrhoea, constipation, a feeling that a bowel movement is not finished, and sometimes whitish mucus. The NHS adds wind, tiredness, nausea, backache, urinary changes and bowel incontinence.

The NHS says flare-ups may be triggered by food or drink, alcohol, caffeine, stress or regular antibiotic use. NIDDK says the cause is unknown and probably a mix of factors, including gut-brain interaction, early-life stress, anxiety or depression, gut infections, small intestinal bacterial overgrowth, food intolerances and genes.

^{27 23}

IBS compared with IBD, celiac disease and lactose intolerance

IBS has no visible damage to the gut. Inflammatory bowel disease (Crohn's disease and ulcerative colitis) is immune-driven inflammation of the gut that can cause bleeding and weight loss. Celiac disease is an immune reaction to gluten that damages the small intestine. Lactose intolerance is trouble digesting milk sugar, with symptoms after dairy.

These conditions overlap with IBS symptoms. The ACG guideline suggests celiac blood tests in IBS with diarrhoea symptoms and a stool calprotectin check to rule out IBD. A 2025 review found about 6 percent of people with IBS had positive celiac blood tests and 2 percent had biopsy-proven celiac disease.

^{24 10 13}

How IBS is diagnosed

NIDDK says routine testing is usually not needed to diagnose IBS. Doctors look for belly pain together with two or more of: pain linked to bowel movements, a change in how often you go, and a change in how stools look, with symptoms at least once a week over 3 months and starting at least 6 months ago. The ACG guideline suggests a positive diagnostic strategy rather than diagnosis by exclusion.

Doctors may order blood and stool tests, and sometimes a breath test, upper endoscopy or colonoscopy, to rule out anemia, infection, celiac disease, IBD, bowel cancer and other conditions. NIDDK lists anemia, rectal bleeding, bloody or black tarry stools and weight loss as signs that point to another problem.

^{25 10}

What established care looks like

Guidelines from the ACG and the British Society of Gastroenterology cover diet, psychological therapies and prescription medicines for particular IBS types. The ACG suggests a limited low-FODMAP trial and gut-directed psychotherapy. The AGA update says soluble fibre is efficacious, a low-FODMAP diet is the most evidence-based diet, and a dietitian can help.

NIDDK says medicines may target diarrhoea, constipation or belly pain, and that some antidepressants at low doses may be used for pain. Choosing any medicine is a decision for you and your clinician; do not start or stop a prescription on your own.

^{10 17 5 28}

What diet, fiber, probiotics, peppermint oil and therapy research shows

Among diets, a low-FODMAP diet has the most support (moderate certainty), fiber and psyllium have modest support, and gluten-free diets have mixed results. CBT and gut-directed hypnotherapy have low-certainty support and are suggested by guidelines. Enteric-coated peppermint oil, probiotics, acupuncture and Chinese herbal medicine each have low-certainty support, and yoga showed no clear difference.

Evidence quality is limited: most diet and behavioural trials cannot hide the treatment from the person, and many pooled analyses were rated low or very low confidence.

^{4 6 14 16 9 15 12}

At a glance

Traditional uses history, not proof

Studied for research

Low-FODMAP diet, moderate certainty (a guideline-suggested short trial)
Soluble fibre and psyllium, low certainty
General healthy-eating advice, low certainty
Gluten-free diet, mixed
CBT and gut-directed hypnotherapy, low certainty (guidelines suggest them)
Mindfulness, low certainty
Exercise, low certainty
Yoga, insufficient
Peppermint oil capsules, low certainty
Probiotics, low certainty
Acupuncture, low certainty
Chinese herbal medicine and Aloe vera, low certainty

Main compounds

FODMAPs
Psyllium
Peppermint oil
Probiotics

Common forms

Dietitian-guided low-FODMAP diet
Psyllium and other fibre supplements
Enteric-coated peppermint oil capsules
Probiotic products
CBT and gut-directed hypnotherapy
Acupuncture
Chinese herbal formulas

Research links: 2021 guideline: American College of Gastroenterology on IBS · 2021 guideline: British Society of Gastroenterology on IBS · 2022 network meta-analysis: low FODMAP diet in IBS · 2022 AGA update: the role of diet in IBS · NIDDK: Definition and facts for IBS · NHS: IBS symptoms · Research Library · Genes & Biomarkers Library

What it is and its history

Accepted scientific name: Irritable bowel syndrome (IBS)
Common names: Irritable bowel syndrome (English); IBS (English); Spastic colon (older term) (English); Síndrome del intestino irritable (Spanish)
Family or group: Disorder of gut-brain interaction. NIDDK describes three types by stool pattern: IBS with constipation (IBS-C), with diarrhoea (IBS-D) and mixed (IBS-M).
Look-alikes and adulterants: Name: Celiac disease; Note: An immune reaction to gluten that damages the small intestine; blood tests are suggested in IBS with diarrhoea.; Name: Inflammatory bowel disease (Crohn's disease, ulcerative colitis); Note: Immune-driven gut inflammation that can cause bleeding and weight loss; stool calprotectin is used to help rule it out.; Name: Lactose intolerance; Note: Trouble digesting milk sugar; NIDDK lists a hydrogen breath test among tests for carbohydrate digestion problems.; Name: Bowel cancer; Note: Can cause bowel changes, blood in the stool and weight loss, so new or changing symptoms need checking.

Traditional use and history history, not clinical proof

Tradition or era	Documented use	Source
Modern guidance	Current guidelines class IBS as a disorder of gut-brain interaction and suggest a positive diagnosis rather than diagnosis only by exclusion. No history older than current guidance was read for this page.	p33903147

Traditional use shows how it was used. It does not show that it works or is safe today.

What is inside, and how it may work

What it contains and how those compounds act in cells and animals. Laboratory and animal mechanisms are not proven effects in people.

Main compounds

Compound	Family	Where it is concentrated	Activity studied	Level of evidence
Peppermint oil	essential oil	Menthol-rich oil from peppermint, used in enteric-coated capsules in trials.	Proposed muscle-relaxing effect; not established in the sources read. ⁹	Human data
Psyllium (ispaghula husk)	soluble fibre	Seed husk fibre that forms a gel in water.	Adds bulk and softness to stool; not tested for mechanism in the sources read. ¹⁴	Human data
FODMAPs	fermentable carbohydrates	Fermentable oligosaccharides, disaccharides, monosaccharides and polyols found in many foods.	Ferment in the gut; the diet cuts back on them. ⁴	Human data
Probiotics	live microorganisms	Products vary by strain and combination.	Proposed effects on gut bacteria; not established. ¹⁵	Human data

Mechanisms, receptors and pathways

Target or pathway	Gene or receptor	What was found	Level
Why IBS happens		NIDDK says the cause is unknown and probably a mix of factors, including brain-gut interaction, early-life stress, mental health conditions, gut infections, small intestinal bacterial overgrowth, food intolerances and genes. ²⁷	Not established

Isolated compounds versus whole extracts

Diets, therapy programmes and herbal products differ between trials, so results for one product or programme cannot be assumed for another.

12benefits and uses looked at

28studies and sources checked

Moderate certaintybest evidence rating found

5lab markers tracked in trials

1 moderate certainty1 mixed findings9 low certainty1 not enough evidence

What was looked at

The 12 benefits and uses checked for Irritable Bowel Syndrome (IBS), each with how strong the evidence is. Tap one to open it.

Low-FODMAP diet (a short, guided trial)Moderate certainty
Soluble fibre and psylliumLow certainty
General healthy-eating advice (NICE-style)Low certainty
Gluten-free diet (without celiac disease)Mixed findings
Gut-directed psychotherapy: CBT and hypnotherapyLow certainty
Mindfulness and meditationLow certainty
Regular physical activityLow certainty
YogaNot enough evidence
Peppermint oil (enteric-coated capsules)Low certainty
ProbioticsLow certainty
AcupunctureLow certainty
Chinese herbal medicine, Aloe vera and other plant productsLow certainty

Lab markers tracked in the studies

Global IBS symptom responseAbdominal painBloating or distensionIBS Symptom Severity Score (IBS-SSS)IBS quality of life (IBS-QOL)

What is Irritable Bowel Syndrome (IBS) good for?

These are the main diet, lifestyle and complementary approaches studied for irritable bowel syndrome and how strong the human evidence is for each. They describe what trials found, not advice to try anything. Established medical care is described in the About tab.

Low-FODMAP diet (a short, guided trial)Moderate certaintyA short guided trial of this diet has the most evidence of any diet, and guidelines suggest it. Soluble fibre and psylliumLow certaintyPsyllium helped more people respond than placebo; overall symptom scores did not change. General healthy-eating advice (NICE-style)Low certaintySimple healthy-eating advice helped some people, less than low FODMAP in studies. Gluten-free diet (without celiac disease)Mixed findingsTwo small trials gave no clear benefit; test for celiac disease first. Gut-directed psychotherapy: CBT and hypnotherapyLow certaintyCBT and gut-directed hypnotherapy beat waiting-list care; guidelines suggest them. Mindfulness and meditationLow certaintyA few small trials suggest better quality of life and pain. Regular physical activityLow certaintyStructured exercise improved the symptom score in a small review. YogaNot enough evidenceEleven trials found no clear difference from control. Peppermint oil (enteric-coated capsules)Low certaintyEnteric-coated capsules beat placebo; more side effects; very low quality evidence. ProbioticsLow certaintySymptom scores improved in pooled trials; no strain has been shown to work. AcupunctureLow certaintyBeat sham needling in a 2026 review, with high variation. Chinese herbal medicine, Aloe vera and other plant productsLow certaintyChinese herbal medicine beat placebo; Aloe vera did not clearly.

Benefits, one by one

Each card is a research question, not a promise. Tap a goal to filter. Open a card to see the studies, doses and limits.

Low-FODMAP diet (a short, guided trial)

Moderate certainty

A diet that cuts back certain hard-to-digest carbohydrates for a few weeks, then adds foods back one at a time. It has the most evidence of any diet for IBS, and guidelines suggest a limited trial, ideally with a dietitian.

5 studiesTrials used a restriction phase, usually followed by reintroduction a…

Studies, doses and limits

What the trials found

A 2022 network meta-analysis of 13 trials (944 patients) ranked a low FODMAP diet first for global symptoms, pain, bloating and bowel habit. A 2025 network meta-analysis of 28 trials (2,338 patients) ranked it fourth for global symptoms, with moderate confidence only in the direct comparison with a habitual diet. A 2018 review rated the evidence very low quality. The 2021 American College of Gastroenterology guideline recommends a limited trial, and the 2022 American Gastroenterological Association update calls it the most evidence-based diet for IBS, in three phases (restriction for no more than 4 to 6 weeks, reintroduction, personalisation).

Results

Global symptoms not improving versus habitual diet: RR 0.67 (2022) and RR 0.51 (2025). Beat NICE-style dietary advice for bloating (RR 0.72).

Effect sizes as reported

2022: RR 0.67 (95% CI 0.48 to 0.91); bloating versus BDA/NICE advice RR 0.72 (0.55 to 0.94). 2025: RR 0.51 (0.37 to 0.70), 24 trials.

Why this rating

Moderate confidence only for the direct comparison with habitual diet in the 2025 network; other comparisons were low or very low, and an earlier review graded the evidence very low. Guidelines support a limited trial.

Form and dose studied

Trials used a restriction phase, usually followed by reintroduction and personalisation. The AGA update says restriction should last no more than 4 to 6 weeks. Amounts and durations are given only as what each study used. They are not advice.

Who was studied

Adults with IBS, mostly seen in secondary or tertiary care.

Limits

Most trials did not study reintroduction; people know which diet they follow; restriction is hard to keep up.

Why researchers looked

Many people with IBS notice that certain foods set off pain, bloating or loose stools, so researchers tested a diet that removes the carbohydrates that ferment in the gut.

Proposed mechanism Hypothesis

Proposed: fewer fermentable carbohydrates means less gas and fluid in the bowel. The trials measured symptoms, not these steps.

A proposed mechanism does not show that the effect happens in people.

The AGA update says restrictive diets are poor choices for people with few culprit foods, a risk of malnutrition, food insecurity, an eating disorder or an uncontrolled psychiatric disorder, and advises working with a dietitian.

^{4 6 7 10 5}

Soluble fibre and psyllium

Low certainty

Fibre supplements, and psyllium (ispaghula) in particular, helped more people respond than placebo. The overall symptom score did not change in a pooled analysis. Fibre should be added slowly.

4 studiesWheat bran, psyllium, inulin-type fructans and beta-galacto-oligosacc…

Studies, doses and limits

What the trials found

A 2026 meta-analysis of 30 trials (1,904 adults) found 52% responded to fibre versus 44% to placebo, with a clearer benefit for psyllium. Across 9 trials of overall symptom scores, there was no significant effect. A 2020 network meta-analysis of 51 trials, only 13 at low risk of bias, did not find soluble fibre clearly better than other active treatments in its summary. The AGA update says soluble fibre is efficacious for global IBS symptoms. NIDDK says soluble fibre (beans, fruit, oat products) seems more helpful than insoluble fibre and advises raising intake slowly to limit gas and bloating.

Results

Clinical response 52% versus 44%; psyllium RR 1.53.

Effect sizes as reported

Response RR 1.21 (95% CI 1.03 to 1.41); psyllium RR 1.53 (1.06 to 2.19); symptom scores SMD -0.25 (-0.67 to 0.17), not significant.

Why this rating

The response result is statistically significant but modest, symptom scores showed no effect, and variation between trials was high. Guidance from the AGA is supportive.

Form and dose studied

Wheat bran, psyllium, inulin-type fructans and beta-galacto-oligosaccharides were studied; results differ by type. Amounts and durations are given only as what each study used. They are not advice.

Who was studied

Adults with IBS; most trials did not report results by IBS subtype.

Limits

Subtype results unavailable; wheat bran and other fibre types behave differently from psyllium.

Why researchers looked

Fibre is one of the oldest suggestions for IBS, especially when constipation is part of it.

Proposed mechanism Hypothesis

Proposed explanations were not tested in the sources read.

A proposed mechanism does not show that the effect happens in people.

NIDDK advises adding fibre slowly to limit gas and bloating.

^{14 2 5 26}

General healthy-eating advice (NICE-style)

Low certainty

Regular meals, sensible fibre, fluids and cutting back on trigger foods helped some people in trials, but less than a low-FODMAP diet in the studies compared.

3 studiesAdvice on meal pattern, fibre, fluids and trigger foods, as used in t…

Studies, doses and limits

What the trials found

The 2025 network meta-analysis ranked a BDA/NICE diet tenth for global symptoms among dietary options (RR 0.62 versus habitual diet; 8 trials), and the 2022 network found it was not superior to any other intervention. The AGA update says healthy-eating advice such as NICE's offers benefit to a subset of people with IBS.

Results

Global symptoms not improving versus habitual diet: RR 0.62.

Effect sizes as reported

RR 0.62 (95% CI 0.43 to 0.90), 8 trials.

Why this rating

Modest benefit across 8 trials, rated low confidence in the network.

Form and dose studied

Advice on meal pattern, fibre, fluids and trigger foods, as used in the trials. Amounts and durations are given only as what each study used. They are not advice.

Who was studied

Adults with IBS.

Limits

Advice differs between trials; people know which advice they received.

Why researchers looked

Before restrictive diets, many guidelines start with simple eating advice.

Proposed mechanism Hypothesis

Proposed explanations were not tested in the sources read.

A proposed mechanism does not show that the effect happens in people.

No harms were described in the sources read.

^{6 4 5}

Gluten-free diet (without celiac disease)

Mixed findings

Some people with IBS feel better off gluten, but the two small trials that tested it did not show a clear benefit. Celiac disease should be tested for before cutting gluten.

5 studiesThe trials compared continuing a gluten-free diet with a diet spiked …

Studies, doses and limits

What the trials found

A 2018 review found two trials (111 people), both in people who had already responded to the diet, and the benefit was not statistically significant. The AGA update says trial results are mixed even though most observational studies report improvement. NIDDK says some people with IBS have more symptoms after gluten without celiac disease. A 2025 meta-analysis of 29 studies found about 6% of people with IBS had positive celiac blood tests and 2% had biopsy-proven celiac disease.

Results

Global symptoms not improving: RR 0.42, not statistically significant.

Effect sizes as reported

RR 0.42 (95% CI 0.11 to 1.55); I2 88%.

Why this rating

Two small trials with very different results; official summaries call the evidence mixed.

Form and dose studied

The trials compared continuing a gluten-free diet with a diet spiked with gluten. Amounts and durations are given only as what each study used. They are not advice.

Who was studied

People with IBS who had responded to a gluten-free diet.

Limits

Only two trials; selection of responders; very high variation.

Why researchers looked

Many people with IBS report symptoms after wheat, so a gluten-free diet is widely tried.

Proposed mechanism Hypothesis

Proposed explanations were not tested in the sources read.

A proposed mechanism does not show that the effect happens in people.

The ACG guideline suggests celiac blood testing in IBS with diarrhoea symptoms, so ask a clinician before starting a gluten-free diet on your own.

^{7 5 13 26 10}

Gut-directed psychotherapy: CBT and hypnotherapy

Low certainty

Talking and relaxation programmes built for IBS, including cognitive behavioural therapy (CBT) and gut-directed hypnotherapy, helped more people than waiting-list or routine care. Guidelines suggest them, though the trials are of low quality.

6 studiesIn person, by phone, online or self-guided CBT, and clinic-led gut-di…

Studies, doses and limits

What the trials found

A 2025 network meta-analysis of 67 trials (7,441 adults) found CBT (9 trials) and gut-directed hypnotherapy (12 trials) beat waiting-list control for global symptoms, with low or very low confidence and signs of publication bias. A 2020 network of 41 trials reached similar conclusions, and a 2024 network of 42 trials found some therapies may help abdominal pain. The ACG guideline suggests gut-directed psychotherapy for global IBS symptoms. NIDDK lists CBT, gut-directed hypnotherapy and relaxation training.

Results

Global symptoms not improving versus waiting list: CBT RR 0.65; hypnotherapy RR 0.79. Abdominal pain: RR 0.71 to 0.77.

Effect sizes as reported

CBT 0.65 (95% CI 0.53 to 0.80); hypnotherapy 0.79 (0.66 to 0.95); pain: minimal-contact CBT 0.71 (0.54 to 0.95), hypnotherapy 0.77 (0.61 to 0.96).

Why this rating

Benefit is consistent across reviews and guidelines suggest it, but all comparisons were low or very low confidence and benefit is probably overestimated.

Form and dose studied

In person, by phone, online or self-guided CBT, and clinic-led gut-directed hypnotherapy. Amounts and durations are given only as what each study used. They are not advice.

Who was studied

Adults with IBS, including some with symptoms that had not responded to routine care.

Limits

High risk of bias; people know which therapy they get; publication bias.

Why researchers looked

IBS is a disorder of gut-brain interaction, so therapies that work on stress, worry and the gut-brain link have been tested.

Proposed mechanism Hypothesis

Proposed: changing how the brain handles signals from the gut. Not tested in the trials read.

A proposed mechanism does not show that the effect happens in people.

No harms were described in the abstracts read.

^{16 3 8 10 17 28}

Mindfulness and meditation

Low certainty

A small group of trials suggests mindfulness may improve quality of life and pain in IBS, though the effect on the symptom score was borderline.

2 studiesMindfulness-based programmes in the trials read. Amounts and duration…

Studies, doses and limits

What the trials found

A 2022 review of 6 trials found quality of life and mindful-awareness scores were higher and pain scores lower with mindfulness. The IBS symptom score change was borderline (p = 0.054). NIDDK lists reducing stress and getting enough sleep among lifestyle changes that may help.

Results

Quality of life and pain improved; symptom score borderline.

Effect sizes as reported

Symptom score 95% CI -74.61 to 0.7 (borderline). Pooled figures in the abstract are on mixed scales.

Why this rating

Few small trials and mixed scales.

Form and dose studied

Mindfulness-based programmes in the trials read. Amounts and durations are given only as what each study used. They are not advice.

Who was studied

Adults with IBS.

Limits

Very few trials; mixed scales; people know they receive mindfulness.

Why researchers looked

Stress can make IBS symptoms worse, so mindfulness has been tried.

Proposed mechanism Hypothesis

Proposed explanations were not tested in the sources read.

A proposed mechanism does not show that the effect happens in people.

No harms were described in the abstract read.

^{1 28}

Regular physical activity

Low certainty

Structured exercise programmes improved the IBS symptom score in a small review, but quality of life and anxiety did not change clearly. There is no agreed exercise plan.

2 studiesPlanned, structured programmes of different types, frequency, intensi…

Studies, doses and limits

What the trials found

A 2026 review of 10 studies (437 patients) found IBS-SSS improved more with exercise than with no exercise. NIDDK lists increasing physical activity among the lifestyle changes that may help.

Results

IBS-SSS improved more with exercise; quality of life and anxiety changes were not significant.

Effect sizes as reported

Pooled numbers were not given in the abstract.

Why this rating

Small review of mixed programmes, with no standard exercise framework.

Form and dose studied

Planned, structured programmes of different types, frequency, intensity and length. Amounts and durations are given only as what each study used. They are not advice.

Who was studied

Adults with IBS.

Limits

Programmes differ; small studies.

Why researchers looked

Activity may help bowel movement and stress, so exercise has been tested for IBS.

Proposed mechanism Hypothesis

Proposed explanations were not tested in the sources read.

A proposed mechanism does not show that the effect happens in people.

No harms were described in the abstract read.

^{18 28}

Yoga

Not enough evidence

Eleven trials found no clear difference from control groups, so yoga cannot yet be called a proven IBS treatment.

1 studiesProgrammes of 6 weeks to 8 months, 40 to 90 minutes a session. Amount…

Studies, doses and limits

What the trials found

A 2025 review of 11 trials (535 patients, including children and adolescents) found no difference in symptom severity, anxiety, depression or quality of life. The authors say yoga cannot be recommended as an IBS treatment until larger trials are done.

Results

No significant difference in symptom severity.

Effect sizes as reported

Symptom severity SMD -0.66 (95% CI -1.51 to 0.18).

Why this rating

Trials are inconsistent and at high risk of bias; the pooled result was not significant.

Form and dose studied

Programmes of 6 weeks to 8 months, 40 to 90 minutes a session. Amounts and durations are given only as what each study used. They are not advice.

Who was studied

Seven adult trials, three in children or adolescents and one in adolescents and young adults.

Limits

Large differences between programmes; high risk of bias.

Why researchers looked

Yoga combines movement, breathing and relaxation, so it is often tried for gut symptoms.

Proposed mechanism Hypothesis

Proposed explanations were not tested in the sources read.

A proposed mechanism does not show that the effect happens in people.

No harms were described in the abstract read.

¹²

Peppermint oil (enteric-coated capsules)

Low certainty

Enteric-coated peppermint oil capsules beat placebo for overall IBS symptoms and abdominal pain in pooled trials, but side effects were more common and the evidence quality is very low.

4 studiesOral enteric-coated capsules were the form mainly studied. Amounts an…

Studies, doses and limits

What the trials found

A 2022 meta-analysis of 10 trials (1,030 patients) found peppermint oil better than placebo for global symptoms (number needed to treat 4) and abdominal pain (number needed to treat 7), with more adverse events and very low quality evidence. A 2020 network meta-analysis ranked peppermint oil capsules first for global symptoms at 4 to 12 weeks, but found no significant differences between active treatments. A 2026 review pooled 7 peppermint trials (RR 1.63). NCCIH says a small body of research, mainly on enteric-coated capsules, suggests it may improve IBS symptoms in adults.

Results

Global symptoms not improving RR 0.65; pain not improving RR 0.76; any adverse event RR 1.57.

Effect sizes as reported

Global 0.65 (95% CI 0.43 to 0.98); pain 0.76 (0.62 to 0.93); adverse events 1.57 (1.04 to 2.37).

Why this rating

Benefit in several pooled analyses, but the 2022 authors rate the evidence very low quality, and adverse events were more frequent.

Form and dose studied

Oral enteric-coated capsules were the form mainly studied. Amounts and durations are given only as what each study used. They are not advice.

Who was studied

Adults with IBS.

Limits

Very low quality; adverse events more frequent; product and capsule coating vary.

Why researchers looked

Peppermint oil relaxes smooth muscle in the lab, so it has been tested for cramping in IBS.

Proposed mechanism Hypothesis

Proposed: relaxing the bowel muscle. The trials measured symptoms, not muscle activity.

A proposed mechanism does not show that the effect happens in people.

NCCIH lists heartburn, nausea, abdominal pain and dry mouth as possible side effects, and says peppermint oil taken alone may worsen indigestion in some people. Enteric coating is often used to reduce heartburn.

^{9 2 11 20}

Probiotics

Low certainty

Pooled trials suggest probiotics may lower IBS symptom scores, but certainty is low and no strain or product has been shown to be the one that works.

2 studiesMany strains and products were pooled, so no single product is descri…

Studies, doses and limits

What the trials found

A 2026 meta-analysis of 40 placebo-controlled trials found probiotics improved IBS-SSS but not IBS quality of life; the evidence was graded low certainty because of inconsistency, and a trial sequential analysis showed more evidence is needed. NCCIH (2019 page) cites a 2018 review of 53 studies that suggested possible benefit but could not say which strains work. NCCIH notes effects vary by product, and a benefit from one strain does not mean others work.

Results

IBS-SSS improved; quality of life did not.

Effect sizes as reported

IBS-SSS mean difference reported as 33.42 (95% CI -55.96 to -10.88); quality of life 1.79 (-3.00 to 6.57).

Why this rating

Low certainty because of inconsistency, and no strain-level conclusions.

Form and dose studied

Many strains and products were pooled, so no single product is described. Amounts and durations are given only as what each study used. They are not advice.

Who was studied

Adults with IBS.

Limits

Products differ; inconsistent results; strain-specific effects unclear.

Why researchers looked

Changes in gut bacteria have been linked to IBS, so probiotics have been tested widely.

Proposed mechanism Hypothesis

Proposed: shifts in gut bacteria or gut lining. Not established in the trials read.

A proposed mechanism does not show that the effect happens in people.

NCCIH says people with severe illness or weakened immune systems face higher risk, severe infections have been reported in premature infants, and some products contain organisms not on the label.

^{15 21}

Acupuncture

Low certainty

A 2026 review found acupuncture beat sham needling for response and symptom severity, but results varied a lot and certainty is low.

1 studiesAcupuncture compared with sham needling at non-acupoints. Amounts and…

Studies, doses and limits

What the trials found

A 2026 meta-analysis of 12 trials (1,105 people) found a higher response rate than sham acupuncture at non-acupoints and lower symptom severity at the end of treatment. Only the response rate and end-of-treatment symptom severity held up in sensitivity analysis. Heterogeneity was high and certainty was low.

Results

Response rate higher than sham.

Effect sizes as reported

Response RR 1.61 (95% CI 1.25 to 2.07); symptom severity SMD 0.79 (0.30 to 1.28).

Why this rating

One recent review with high variation (I2 77 to 86 percent) and low certainty.

Form and dose studied

Acupuncture compared with sham needling at non-acupoints. Amounts and durations are given only as what each study used. They are not advice.

Who was studied

Adults and others with IBS across 12 trials.

Limits

High heterogeneity; sham needling is hard to blind.

Why researchers looked

Acupuncture is widely used for digestive complaints, so trials have compared it with sham needling.

Proposed mechanism Hypothesis

Proposed explanations were not tested in the sources read.

A proposed mechanism does not show that the effect happens in people.

No harms were described in the abstract read.

¹⁹

Chinese herbal medicine, Aloe vera and other plant products

Low certainty

Chinese herbal medicine did better than placebo in pooled trials; Aloe vera did not show a clear benefit; other herbs have too little data to judge.

1 studiesFormulas and products varied between the studies. Amounts and duratio…

Studies, doses and limits

What the trials found

A 2026 meta-analysis of 60 studies (6,329 patients) pooled Chinese herbal medicine (7 studies, RR 1.56), Aloe vera (3 studies, RR 1.25, not significant) and peppermint oil. St John's wort and anise oil had too few data to pool. The authors note the quality of many studies was limited. Chinese herbal formulas differ between studies, so results do not apply to a single product.

Results

Chinese herbal medicine RR 1.56; Aloe vera RR 1.25 (not significant).

Effect sizes as reported

Chinese herbal medicine 1.27 to 1.92; Aloe vera 0.76 to 2.06.

Why this rating

Based on one review that pooled mixed formulas of limited quality.

Form and dose studied

Formulas and products varied between the studies. Amounts and durations are given only as what each study used. They are not advice.

Who was studied

Adults with IBS.

Limits

Mixed formulas; limited-quality studies; most trials not read in detail.

Why researchers looked

Herbal products are widely used for IBS.

Proposed mechanism Hypothesis

Proposed explanations were not tested in the sources read.

A proposed mechanism does not show that the effect happens in people.

The abstract says peppermint oil and Chinese herbal medicine had a good safety profile, but products and formulas differ. Herbs can interact with medicines (see the Safety tab).

¹¹

Connections to the rest of health

How Irritable Bowel Syndrome (IBS) connects to the rest of our health knowledge graph. Every link says what kind of connection it is. A safety link (for example to the liver) is a warning, not a benefit. A study that merely mentions a topic never creates a benefit link.

Explore every connection: goals, body systems, organs, symptoms, genes

Kind of connection Connected to Search

A. Wellness goals

Connected to	Kind of connection	Evidence status	Context	Studies
Gut Digestive Health		Moderate certainty	Low-FODMAP diet (a short, guided trial): A diet that cuts back certain hard-to-digest carbohydrates for a few weeks, then adds foods back one at a time. It has the most evidence of any diet for IBS, and guidelines suggest a limited trial, ideally with a dietitian. Soluble fibre and psyllium: Fibre supplements, and psyllium (ispaghula) in particular, helped more people respond than placebo. The overall symptom score did not change in a pooled analysis. Fibre should be added slowly.	^{4 6 7 10 5 14 2 26 13 16 3 8 17 28 1 18 12 9 11 20 15 21 19}

B. Body systems

Connected to	Kind of connection	Evidence status	Context	Studies
Digestive System	Biological association	Moderate certainty	Studied for: Low-FODMAP diet (a short, guided trial) Studied for: Soluble fibre and psyllium	^{4 6 7 10 5 14 2 26 13 16 3 8 17 28 1 18 12 9 11 20 15 21 19}
Nervous System	Biological association	Low certainty	Studied for: Gut-directed psychotherapy: CBT and hypnotherapy Studied for: Mindfulness and meditation	^{16 3 8 10 17 28 1 12}

E. Health conditions

Connected to	Evidence status	Context	Studies
Celiac disease	Meta analysis	About 6 percent of people with IBS had positive celiac blood tests. Preparation or compound: Blood tests	^{13 10}
Inflammatory bowel disease	Guideline	The ACG guideline suggests a calprotectin check in suspected IBS with diarrhoea. Preparation or compound: Fecal calprotectin	¹⁰
Low-FODMAP diet	Moderate certainty	A guideline-suggested short trial with the most evidence of any diet. Preparation or compound: Low-FODMAP diet	^{4 6}

I. Biomarkers

Connected to	Kind of connection	Evidence status	Context	Studies
Global IBS symptom response	Biological association	Low certainty	Measured in trials: Fewer people not improving is better. A lab change is not the same as a health benefit.	^{4 16 14}
Abdominal pain	Biological association	Low certainty	Measured in trials: Less pain is better. A lab change is not the same as a health benefit.	⁸
Bloating or distension	Biological association	Moderate certainty	Measured in trials: Less bloating is better. A lab change is not the same as a health benefit.	^{4 6}
IBS Symptom Severity Score (IBS-SSS)	Biological association	Low certainty	Measured in trials: Lower is better. A lab change is not the same as a health benefit.	^{15 18}
IBS quality of life (IBS-QOL)	Biological association	Low certainty	Measured in trials: Higher is better. A lab change is not the same as a health benefit.	^{15 18 1}

L. Active compounds

Connected to	Kind of connection	Evidence status	Context	Studies
Peppermint oil	Biological association	Human	Proposed muscle-relaxing effect; not established in the sources read.	⁹
Psyllium (ispaghula husk)	Biological association	Human	Adds bulk and softness to stool; not tested for mechanism in the sources read.	¹⁴
FODMAPs	Biological association	Human	Ferment in the gut; the diet cuts back on them.	⁴
Probiotics	Biological association	Human	Proposed effects on gut bacteria; not established.	¹⁵

Each connection is stored with the ingredient, the connected record, the kind of connection, the evidence status, the supporting studies, the preparation or compound involved, and a review date (last reviewed October 31, 2026).

Evidence at a glance: what the research found for 12 outcomes

1Moderate certainty

9Low certainty

1Mixed findings

1Not enough evidence

Each outcome below is one thing researchers measured. Certainty is how far the evidence can be trusted, not how well it works. The full studies are on the next tab.

Low-FODMAP diet (a short, guided trial) 5 studies Moderate certainty Soluble fibre and psyllium 4 studies Low certainty General healthy-eating advice (NICE-style) 3 studies Low certainty Gluten-free diet (without celiac disease) 5 studies Mixed findings Gut-directed psychotherapy: CBT and hypnotherapy 6 studies Low certainty Mindfulness and meditation 2 studies Low certainty Regular physical activity 2 studies Low certainty Yoga 1 study Not enough evidence Peppermint oil (enteric-coated capsules) 4 studies Low certainty Probiotics 2 studies Low certainty Acupuncture 1 study Low certainty Chinese herbal medicine, Aloe vera and other plant products 1 study Low certainty

The evidence

The research centre for Irritable Bowel Syndrome (IBS). Every record here was checked against PubMed or the publisher's page; we never list a study we have not verified.

Evidence by outcome

Bars show how many studies we found for each outcome, not how well it works. People are added up across trials only (reviews are not added, to avoid double counting).

How we rate evidence

High certainty

Several well-run trials or reviews agree; further research is unlikely to change the picture much.

Moderate certainty

Good trials point the same way, but some doubt remains.

Low certainty

Small, short or inconsistent trials. The finding could change with better research.

Very low certainty

Very little or very weak human data. Treat as a possibility only.

Mixed findings

Trials or reviews disagree with each other.

Not enough evidence

Not enough human research to say either way.

Evidence against

Good research found no benefit, or found harm.

We take the reviewers' own risk-of-bias and GRADE statements where they exist, and otherwise judge from study size, design, consistency, directness and whether a product matches what is sold. Many publications do not make evidence high. Method note: We searched PubMed, re-read the abstract of every review and trial cited, and read the NIDDK, NCCIH and NHS pages through a tool that summarises pages. Full texts were not read. Certainty ratings are the compiler's own reading, except where a guideline gives its own grade (stated in the text). Funding is not stated in most abstracts, and this is noted where relevant.

Study library: every study we checked 28

Design Research type Year from Search

Study	Design	People	Product, dose, length	Result
Baboş 2022 Meditation and Irritable Bowel Syndrome, a Systematic Review and Meta-Analysis. J Clin Med · PMID 36362745 · DOI	Systematic review meta analysis	6 randomised trials in adults with IBS selected from 604 articles	Meditation or mindfulness-based therapy Not given in the abstract · vs Control groups	Quality of life and mindful-awareness scores were higher and pain scores lower in the mindfulness groups. The change in IBS symptom score was borderline (p = 0.054). Symptom score SMD -36.95 (borderline); the abstract reports pain as significantly lower (95% CI -74.61 to 0.7 for symptom score) Methods, limits and funding Outcomes: IBS symptom score, quality of life, pain, anxiety, depression Limitations: Few trials; very mixed scales; the pooled figures printed in the abstract are on different scales so only the direction is used here. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Black 2020 Efficacy of soluble fibre, antispasmodic drugs, and gut-brain neuromodulators in irritable bowel syndrome: a systematic review and network meta-analysis. Lancet Gastroenterol Hepatol · PMID 31859183 · DOI	Systematic review meta analysis	4644 51 randomised trials (4,644 patients) of soluble fibre, antispasmodics, peppermint oil and gut-brain neuromodulators in IBS; only 13 trials at low risk of bias	Peppermint oil capsules among the treatments compared (plus fibre, drugs) Not given in the abstract · vs Placebo or head-to-head	Peppermint oil capsules ranked first for global symptoms at 4 to 12 weeks, ahead of tricyclic antidepressants, but there were no significant differences between active treatments on direct or indirect comparison. This record is used here for the peppermint oil result only. Peppermint oil, global symptoms not improving: RR 0.63 (95% CI 0.48 to 0.83) Methods, limits and funding Outcomes: Failure to improve global IBS symptoms at 4 to 12 weeks; abdominal pain Limitations: Only 13 of 51 trials at low risk of bias; rankings are not proof that one treatment beats another. Funding and conflicts: Funding not stated in the abstract. Read: abstract
Black 2020 Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis. Gut · PMID 32276950 · DOI	Systematic review meta analysis	4072 41 randomised trials (4,072 adults with IBS)	Psychological therapies including CBT and gut-directed hypnotherapy Not given in the abstract · vs Control interventions, routine care or each other	Self-administered or minimal contact CBT, face-to-face CBT and gut-directed hypnotherapy had the largest evidence bases and were efficacious, with none shown to be better than another. Risk of bias was high and funnel plot asymmetry suggests benefit is probably overestimated. Remaining symptomatic: minimal-contact CBT RR 0.61; face-to-face CBT 0.62; gut-directed hypnotherapy 0.67 (95% CI 0.45 to 0.83; 0.48 to 0.80; 0.49 to 0.91) Methods, limits and funding Outcomes: Remaining symptomatic after therapy Limitations: High risk of bias; likely overestimated benefit. Funding and conflicts: Registered on PROSPERO (CRD 42020163246); funding not stated in the abstract. Read: abstract
Black 2022 Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut · PMID 34376515 · DOI	Systematic review meta analysis	944 13 randomised trials (944 patients) of a low FODMAP diet in IBS; searched to April 2021	Low FODMAP diet Not given in the abstract · vs Habitual diet, other dietary advice (including British Dietetic Association/NICE advice) and other control diets	A low FODMAP diet ranked first for global symptoms versus habitual diet and was superior to all other interventions. It ranked first for pain, bloating and bowel habit, and beat BDA/NICE dietary advice for bloating or distension. Most trials were in secondary or tertiary care and did not study reintroduction and personalisation. Global symptoms not improving: RR 0.67 versus habitual diet; bloating: RR 0.72 versus BDA/NICE advice (95% CI 0.48 to 0.91; 0.55 to 0.94) Methods, limits and funding Outcomes: Global IBS symptoms, abdominal pain, bloating or distension, bowel habit Limitations: Mostly specialist-care settings; reintroduction and personalisation phases not studied; people know which diet they follow. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Chey 2022 AGA Clinical Practice Update on the Role of Diet in Irritable Bowel Syndrome: Expert Review. Gastroenterology · PMID 35337654 · DOI	Clinical practice guideline	Adults with IBS	Dietary management: soluble fibre, low FODMAP diet, healthy-eating advice, gluten-free diet Low FODMAP restriction no longer than 4 to 6 weeks, then reintroduction and personalisation · vs Not a trial	The update says soluble fibre is efficacious for global IBS symptoms and a low FODMAP diet is the most evidence-based diet; healthy-eating advice such as NICE's also helps some people. Gluten-free diet results from randomised trials are mixed. Restrictive diets are poor choices for people with few culprit foods, malnutrition risk, food insecurity, an eating disorder or an uncontrolled psychiatric disorder, and a dietitian is advised. Best-practice statements; not a systematic review and not formally graded (Not given in the abstract) Methods, limits and funding Outcomes: Not given in the abstract Limitations: Expert opinion plus literature review; the authors state no formal rating of evidence was done. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Cuffe 2025 Efficacy of dietary interventions in irritable bowel syndrome: a systematic review and network meta-analysis. Lancet Gastroenterol Hepatol · PMID 40258374 · DOI	Systematic review meta analysis	2338 28 randomised trials (2,338 patients) of 11 dietary interventions in IBS	Low FODMAP, BDA/NICE, lactose-reduced, starch- and sucrose-reduced, personalised and Mediterranean diets, among others Not given in the abstract · vs Habitual diet, sham diet, high FODMAP diet or other dietary advice	For global symptoms, a starch- and sucrose-reduced diet ranked first (2 trials), a low FODMAP diet fourth (24 trials) and a BDA/NICE diet tenth (8 trials), versus habitual diet. Only a low FODMAP diet beat habitual diet for bloating. Almost all comparisons were rated low or very low confidence; the direct comparisons of low FODMAP or starch- and sucrose-reduced diet with habitual diet were moderate. Global symptoms not improving versus habitual diet: low FODMAP RR 0.51; BDA/NICE 0.62; starch/sucrose-reduced 0.41 (95% CI 0.37 to 0.70; 0.43 to 0.90; 0.26 to 0.67) Methods, limits and funding Outcomes: Global IBS symptoms, abdominal pain, bloating or distension, bowel habit Limitations: Low or very low confidence for nearly all comparisons; the starch- and sucrose-reduced result rests on two trials; diets cannot be blinded. Funding and conflicts: Funding: none. Read: abstract
Dionne 2018 A Systematic Review and Meta-Analysis Evaluating the Efficacy of a Gluten-Free Diet and a Low FODMAPs Diet in Treating Symptoms of Irritable Bowel Syndrome. Am J Gastroenterol · PMID 30046155 · DOI	Systematic review meta analysis	508 9 randomised trials: 2 trials of a gluten-free diet (111 people) and 7 of a low FODMAP diet (397 people)	Gluten-free diet; low FODMAP diet Not given in the abstract · vs Control or usual diets (gluten trials re-introduced gluten in the control arm)	A gluten-free diet lowered global symptoms but the result was not statistically significant. A low FODMAP diet reduced global symptoms, but GRADE quality was very low. The authors conclude there is insufficient evidence to recommend a gluten-free diet. Gluten-free: RR 0.42 (not significant). Low FODMAP: RR 0.69 (95% CI 0.11 to 1.55; 0.54 to 0.88) Methods, limits and funding Outcomes: Global IBS symptoms, abdominal pain Limitations: Only two gluten trials, both in people who had already responded to the diet; very low quality. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Goodoory 2024 Effect of Brain-Gut Behavioral Treatments on Abdominal Pain in Irritable Bowel Syndrome: Systematic Review and Network Meta-Analysis. Gastroenterology · PMID 38777133 · DOI	Systematic review meta analysis	5220 42 randomised trials (5,220 adults with IBS)	Brain-gut behavioural treatments: self-guided or minimal contact CBT, face-to-face multicomponent behavioural therapy, gut-directed hypnotherapy Not given in the abstract · vs Control interventions or each other	Self-guided or minimal contact CBT, face-to-face multicomponent behavioural therapy and face-to-face gut-directed hypnotherapy may help abdominal pain. No trial was at low risk of bias in all areas and there was funnel plot asymmetry. Pain not improving: minimal-contact CBT RR 0.71; multicomponent therapy 0.72; hypnotherapy 0.77 (95% CI 0.54 to 0.95; 0.54 to 0.97; 0.61 to 0.96) Methods, limits and funding Outcomes: Abdominal pain resolution or improvement at the end of treatment Limitations: No trial at low risk of bias in all domains; funnel plot asymmetry. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Ingrosso 2022 Systematic review and meta-analysis: efficacy of peppermint oil in irritable bowel syndrome. Aliment Pharmacol Ther · PMID 35942669 · DOI	Systematic review meta analysis	1030 10 randomised trials (1,030 patients) of peppermint oil versus placebo in IBS	Peppermint oil Not given in the abstract · vs Placebo	Peppermint oil beat placebo for global symptoms and abdominal pain, but adverse events were more frequent, and the authors rate the quality of evidence as very low. Global symptoms not improving RR 0.65 (NNT 4); pain not improving RR 0.76 (NNT 7); any adverse event RR 1.57 (95% CI 0.43 to 0.98; 0.62 to 0.93; 1.04 to 2.37) Methods, limits and funding Outcomes: Global IBS symptoms, abdominal pain, adverse events, reflux Limitations: Very low quality evidence; more adverse events; adequately powered trials still needed. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Lacy 2021 ACG Clinical Guideline: Management of Irritable Bowel Syndrome. Am J Gastroenterol · PMID 33315591 · DOI	Clinical practice guideline	Adults with IBS; 25 clinical questions (9 on diagnostic testing, 16 on treatment) graded with GRADE	Positive diagnosis, celiac blood test, stool calprotectin, limited low-FODMAP trial, gut-directed psychotherapy, plus specific prescription medicines by IBS type Not a trial · vs Not given in the abstract	The guideline suggests a positive diagnostic strategy rather than diagnosis by exclusion, celiac blood testing in IBS with diarrhoea symptoms, and a fecal calprotectin check to rule out inflammatory bowel disease. It recommends a limited trial of a low-FODMAP diet and suggests gut-directed psychotherapy for global IBS symptoms. It also recommends certain prescription medicines for constipation-type and diarrhoea-type IBS (named in the guideline). Recommendation statements only; no pooled numbers in the abstract (Not given in the abstract) Methods, limits and funding Outcomes: Diagnostic strategy, global IBS symptoms Limitations: Guideline from a US medical society; the abstract does not give the evidence grade for each statement; the full text was not read. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Meyer 2026 Systematic Review and Meta-Analysis: Plant-Based Therapy for Irritable Bowel Syndrome. Phytother Res · PMID 42572206 · DOI	Systematic review meta analysis	6329 60 studies (6,329 patients) of plant-based therapies in IBS; searched to May 2024	Fibre, peppermint oil, Aloe vera and Chinese herbal medicine (pooled); St John's wort and anise oil (too few data to pool) Not given in the abstract · vs Placebo	Peppermint oil (7 studies) and Chinese herbal medicine (7 studies) beat placebo; fibre approached significance; Aloe vera (3 studies) showed no clear benefit. The quality of many studies was limited. Peppermint oil RR 1.63; Chinese herbal medicine RR 1.56; fibre RR 1.22; Aloe vera RR 1.25 (not significant) (95% CI 1.33 to 2.00; 1.27 to 1.92; 1.00 to 1.49; 0.76 to 2.06) Methods, limits and funding Outcomes: Dichotomous rating of change in IBS symptoms Limitations: Many studies of limited quality; Chinese herbal formulas differ from one another. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Saab 2025 Yoga for Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Gastroenterol · PMID 40358469 · DOI	Systematic review meta analysis	535 11 randomised trials (535 patients; adults, children and adolescents)	Yoga programmes of 6 weeks to 8 months, 40 to 90 minutes a session 6 weeks to 8 months · vs Control groups	Yoga made no clear difference to symptom severity, anxiety, depression or quality of life. The authors say yoga cannot be recommended as a treatment for IBS before larger trials. GI symptom severity SMD -0.66 (not significant) (95% CI -1.51 to 0.18) Methods, limits and funding Outcomes: GI symptom severity, anxiety, depression, quality of life Limitations: Considerable method differences between trials and high risk of bias; PROSPERO CRD42024611633. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Shiha 2025 Global Prevalence of Celiac Disease in Patients With Rome III and Rome IV Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis. Am J Gastroenterol · PMID 40493044 · DOI	Systematic review meta analysis	7209 29 studies (7,209 people with IBS) that screened for celiac disease	Celiac blood tests (serology) and biopsy Not given in the abstract · vs Controls without IBS	About 6 percent of people with IBS had positive celiac blood tests and about 2 percent had biopsy-proven celiac disease, and IBS carried higher odds of positive serology than controls. The authors conclude a positive IBS diagnosis should not be made without excluding celiac disease. No US studies were included. Seroprevalence 6%; biopsy-proven 2%; odds ratio for positive serology 4.42 (95% CI 5% to 8%; 2% to 3%; 2.82 to 6.92) Methods, limits and funding Outcomes: Pooled celiac prevalence in IBS Limitations: Few European studies and none from the United States; 15 percent of seropositive people did not have a biopsy. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Staudacher 2026 Fiber Supplementation in Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Gastroenterology · PMID 42600900 · DOI	Systematic review meta analysis	1904 30 randomised trials (1,904 adults with IBS) of fibre supplements against placebo; 16 trials (1,293 people) reported clinical response	Fibre supplements (wheat bran 7 trials, psyllium 6, inulin-type fructans 5, beta-galacto-oligosaccharides 2) Not given in the abstract · vs Suitable placebo	52% responded to fibre versus 44% to placebo, with a benefit for psyllium specifically. Across 9 trials of overall symptom scores there was no significant effect, apart from beta-galacto-oligosaccharides. Results by IBS subtype could not be analysed for most outcomes. Clinical response RR 1.21 overall; psyllium RR 1.53; symptom scores SMD -0.25 (not significant) (95% CI 1.03 to 1.41; 1.06 to 2.19; -0.67 to 0.17) Methods, limits and funding Outcomes: Clinical response; overall GI symptom scores Limitations: Moderate to high variation between trials for symptom scores (I2 78%); subtype results unavailable; registered on PROSPERO (CRD42024600758). Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Tang 2026 Probiotics for Irritable Bowel Syndrome: An Updated Systematic Review and Meta-Analysis With Trial Sequential Analysis. J Gastroenterol Hepatol · PMID 41820241 · DOI	Systematic review meta analysis	40 randomised trials comparing probiotics with placebo in adults with IBS	Probiotics (strains and products varied) Varied · vs Placebo	Probiotics improved IBS-SSS but not IBS quality of life. Trial sequential analysis showed the required evidence size had not yet been reached, and certainty was low, mainly because of inconsistency. Most studies were at low risk of bias. IBS-SSS mean difference reported as 33.42 (a drop in score is better); quality of life MD 1.79 (not significant) (95% CI -55.96 to -10.88; -3.00 to 6.57) Methods, limits and funding Outcomes: IBS Symptom Severity Score (IBS-SSS); IBS quality of life Limitations: Low certainty because of inconsistency; the sign of the IBS-SSS figure in the abstract text looks mis-typed, so only the direction (improvement) is used here; participant number not given in the abstract. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Thakur 2025 Efficacy of behavioural therapies for irritable bowel syndrome: a systematic review and network meta-analysis. Lancet Gastroenterol Hepatol · PMID 41077057 · DOI	Systematic review meta analysis	7441 67 randomised trials (7,441 adults with IBS)	Behavioural therapies including cognitive behavioural therapy (CBT), gut-directed hypnotherapy, dynamic psychotherapy and self-management Not given in the abstract · vs Waiting list, attention placebo or routine care	Compared with waiting list, several therapies helped, among them CBT (9 trials, 1,150 patients), minimal contact CBT, internet-based minimal contact CBT and gut-directed hypnotherapy (12 trials, 1,507 patients). Confidence in all comparisons was low or very low, with signs of publication bias and no trial at low risk of bias across all domains. Global symptoms not improving versus waiting list: CBT RR 0.65; gut-directed hypnotherapy RR 0.79 (95% CI 0.53 to 0.80; 0.66 to 0.95) Methods, limits and funding Outcomes: Improvement in global IBS symptoms after treatment Limitations: Low or very low confidence; publication bias; people know which therapy they receive. Funding and conflicts: Funding: none. Read: abstract
Vasant 2021 British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut · PMID 33903147 · DOI	Clinical practice guideline	Adults with IBS; recommendations built on updated trial-based and network meta-analyses of diet, drug and psychological therapies	Dietary, pharmacological and psychological management of IBS Not a trial · vs Not given in the abstract	The guideline re-classifies IBS as a disorder of gut-brain interaction and gives GRADE-graded recommendations for diagnosis and treatment, based on a comprehensive literature search and updated network meta-analyses. The abstract does not list the individual recommendations. Recommendation grades only; none given in the abstract (Not given in the abstract) Methods, limits and funding Outcomes: Efficacy of dietary, drug and psychological therapies Limitations: Individual recommendations were not in the abstract and the full text was not read. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Wu 2026 Evaluation of the effectiveness of exercise therapy for irritable bowel syndrome: a systematic review and meta-analysis. Front Med (Lausanne) · PMID 41884124 · DOI	Systematic review meta analysis	437 10 studies (437 patients with IBS) comparing exercise with no exercise; searched to February 2025	Planned, structured exercise programmes of varied type, frequency and length Varied between studies · vs No exercise	IBS-SSS improved more in the exercise groups. Quality of life and anxiety changes were not statistically significant. The authors note there is no agreed exercise prescription for IBS. Pooled numbers were not given in the abstract (Not given in the abstract) Methods, limits and funding Outcomes: IBS Symptom Severity Score (IBS-SSS), IBS quality of life, anxiety Limitations: Small, mixed programmes; no standard exercise framework; some included studies may not be randomised (the abstract says 'studies'); registered on PROSPERO (CRD420250478248). Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Zheng 2026 Acupuncture Versus Sham Non-Acupoint Acupuncture for Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis. Gastroenterology · PMID 42413705 · DOI	Systematic review meta analysis	1105 12 randomised trials (1,105 people with IBS); 11 pooled	Acupuncture Varied · vs Sham acupuncture at non-acupoints	Acupuncture gave a higher response rate and lower symptom severity at the end of treatment than sham needling. Only the response rate and end-of-treatment symptom severity held up in sensitivity analysis. Heterogeneity was high and certainty low. Response RR 1.61; symptom severity SMD 0.79 at end of treatment (95% CI 1.25 to 2.07; 0.30 to 1.28) Methods, limits and funding Outcomes: Response rate, overall symptom severity, quality of life Limitations: High heterogeneity (I2 77 to 86 percent); low certainty; sham needling is hard to blind. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
s-nccih-peppermint NCCIH: Peppermint oil (last updated May 2025) · Source	Health agency n/a			Methods, limits and funding Read: full-text
s-nccih-probiotics NCCIH: Probiotics, usefulness and safety (last updated August 2019) · Source	Health agency n/a			Methods, limits and funding Read: full-text
s-nhs-bowel-cancer NHS: Bowel cancer, symptoms (reviewed 4 September 2026) · Source	Health agency n/a			Methods, limits and funding Read: full-text
s-nhs-ibs-symptoms NHS: Irritable bowel syndrome (IBS), symptoms (reviewed 17 March 2025) · Source	Health agency n/a			Methods, limits and funding Read: full-text
s-niddk-definition NIDDK: Definition and facts for irritable bowel syndrome (last reviewed November 2017) · Source	Health agency n/a			Methods, limits and funding Read: full-text
s-niddk-diagnosis NIDDK: Diagnosis of irritable bowel syndrome (last reviewed November 2017) · Source	Health agency n/a			Methods, limits and funding Read: full-text
s-niddk-diet NIDDK: Eating, diet and nutrition for irritable bowel syndrome (last reviewed November 2017) · Source	Health agency n/a			Methods, limits and funding Read: full-text
s-niddk-symptoms NIDDK: Symptoms and causes of irritable bowel syndrome (last reviewed November 2017) · Source	Health agency n/a			Methods, limits and funding Read: full-text
s-niddk-treatment NIDDK: Treatment for irritable bowel syndrome (last reviewed November 2017) · Source	Health agency n/a			Methods, limits and funding Read: full-text

What we do not know yet

No long, large placebo-controlled trial of one named probiotic strain for IBS was read.
Most diet and behavioural trials cannot hide the treatment from the person, so expectation effects are not separated out.
Results by IBS subtype were not available for fibre.
Peppermint oil, acupuncture and herbal trials were read only as pooled reviews, not trial by trial.
The NIDDK pages read are dated 2017.
Full texts were not read.

How new research is added

New studies are found by a saved PubMed search and placed in a review queue before the page changes.

Lab markers

What changed in blood or saliva tests during trials. A changed number is not the same as feeling or being healthier, and we give no "normal ranges".

Other 5

●

Global IBS symptom response

Fewer people not improving is better in trials

Whether a person reports their overall IBS symptoms improved after treatment.

Low certainty

Results and what it means

Why it was measured

Trials use it as the main yes-or-no outcome.

Statistical vs. clinical meaning

The outcome people say matters most, but it is self-rated and people know their treatment.

Study	Result	People	Product
⁴	Fewer people not improving than with habitual diet (RR 0.67).	944 patients in 13 trials	Low FODMAP diet
¹⁶	Fewer not improving than waiting list (CBT RR 0.65; hypnotherapy RR 0.79).	7,441 adults in 67 trials	CBT, gut-directed hypnotherapy
¹⁴	52% responded to fibre versus 44% to placebo.	1,293 adults in 16 trials	Fibre supplements

^{4 16 14}

●

Abdominal pain

Less pain is better in trials

How often or how badly the belly hurts, reported by the person.

Low certainty

Results and what it means

Why it was measured

Pain is a main reason people seek care.

Statistical vs. clinical meaning

Several behavioural therapies may help pain, with funnel plot asymmetry.

Study	Result	People	Product
⁸	Pain not improving RR 0.71 to 0.77 for minimal-contact CBT and hypnotherapy.	5,220 adults in 42 trials	Brain-gut behavioural treatments

⁸

●

Bloating or distension

Less bloating is better in trials

How swollen or full the belly feels.

Moderate certainty

Results and what it means

Why it was measured

A common and bothersome IBS symptom.

Statistical vs. clinical meaning

Moderate confidence for the direct comparison with habitual diet in the 2025 network.

Study	Result	People	Product
⁴	Low FODMAP beat NICE-style advice for bloating (RR 0.72).	944 patients in 13 trials	Low FODMAP diet
⁶	Only a low FODMAP diet beat habitual diet for bloating (RR 0.55).	2,338 patients in 28 trials	Dietary interventions

^{4 6}

●

IBS Symptom Severity Score (IBS-SSS)

Lower is better in trials

A questionnaire score combining pain, bloating, bowel habit and effect on daily life; lower means milder IBS.

Low certainty

Results and what it means

Why it was measured

Used in trials as a continuous symptom measure.

Statistical vs. clinical meaning

Both results rest on low-certainty evidence.

Study	Result	People	Product
¹⁵	Probiotics lowered IBS-SSS (low certainty).	40 trials	Probiotics
¹⁸	IBS-SSS improved more with exercise.	437 patients in 10 studies	Exercise

^{15 18}

●

IBS quality of life (IBS-QOL)

Higher is better in trials

A questionnaire on how IBS affects daily life.

Low certainty

Results and what it means

Why it was measured

Shows whether symptom gains matter in daily life.

Statistical vs. clinical meaning

Mixed: gains with mindfulness, none clear with probiotics or exercise.

Study	Result	People	Product
¹⁵	No significant change with probiotics.	40 trials	Probiotics
¹⁸	No significant change with exercise.	437 patients in 10 studies	Exercise
¹	Quality of life higher with mindfulness.	6 trials	Mindfulness

^{15 18 1}

Safety

What studies and official sources say about side effects, medicines and who should check first. Each point shows what kind of evidence it comes from.

Main points to know 4

See a doctor about new, changing or worrying bowel symptoms. The NHS says to see a GP if you think you have IBS and symptoms have lasted more than 4 weeks, and to request an urgent appointment or contact NHS 111 for unexplained weight loss, bleeding from the bottom or bloody diarrhoea, a hard lump or swelling in the tummy, or breathlessness, palpitations or unusually pale skin. NIDDK lists anemia, rectal bleeding, bloody or black tarry stools and weight loss as signs that point to another problem. Do not assume bowel symptoms are IBS without a clinician's check. Health agency guidance ^{23 25 22}
IBS can look like celiac disease or inflammatory bowel disease. A 2025 review found about 6 percent of people with IBS had positive celiac blood tests, and its authors say IBS should not be diagnosed without excluding celiac disease. The ACG guideline suggests celiac blood tests in IBS with diarrhoea and a stool calprotectin check for inflammatory bowel disease. Ask a clinician about testing before changing your diet or stopping any care. Guideline and meta analysis ^{13 10}
Restrictive diets are not for everyone. The AGA update says people with few culprit foods, a risk of malnutrition, food insecurity, an eating disorder or an uncontrolled psychiatric disorder are poor candidates for restrictive diets such as low FODMAP, and advises referral to a dietitian. If eating or food worries are causing distress, talk to a clinician. Guideline ⁵
This page does not replace care. IBS is diagnosed and managed by a clinician. Guidelines also list prescription medicines for particular IBS types, which are a matter for you and your clinician. The natural and lifestyle options on this page are things to discuss, not replacements for care. Guideline ^{10 17}

Side effects 4

Effect	How often	Severity and recovery	Evidence
Heartburn, nausea, belly pain or dry mouth from peppermint oil NCCIH lists heartburn, nausea, abdominal pain and dry mouth, says peppermint oil taken alone may worsen indigestion in some people, and says enteric-coated capsules are often used to reduce heartburn. Allergic reactions are rare.	Adverse events were more frequent than with placebo (RR 1.57)	Mild to moderate Not stated	Meta analysis and health agency guidance ^{9 20}
Gas and bloating when fibre is increased quickly NIDDK advises adding fibre slowly to limit gas and bloating.	Not given	Mild Not stated	Health agency guidance ²⁶
Nutritional gaps and food fear with long restrictive diets The AGA update advises that a low FODMAP restriction phase should not last beyond 4 to 6 weeks and that each diet be tried for a set time, then stopped if it is not helping.	Not given	Varies Not stated	Expert guidance ⁵
Infection or unlisted ingredients with probiotics NCCIH says severe or fatal infections have been reported in premature infants given probiotics and that some products contain organisms not listed on the label.	Rare	Can be serious in people with weakened immune systems Not stated	Health agency guidance ²¹

Medicines and supplements 2

With	Why it matters	Importance	Evidence	What to do
Medicines, in general, when starting any herbal product general	Some herbs and medicines interact harmfully.	NCCIH advises talking with a health care provider before using any herbal product if you take medication; it lists no specific interactions for peppermint oil.	Health agency guidance Not enough evidence ²⁰	Tell your clinician or pharmacist about every herb and supplement you use, including peppermint oil, Chinese herbal products and probiotics.
Medicines that suppress the immune system, with probiotics prescription	Live microorganisms can cause infection when the immune system is weak.	NCCIH says people with severe illnesses or weakened immune systems face a higher risk of harm from probiotics.	Health agency guidance Low certainty ²¹	Ask the clinician managing your condition before using probiotics.

Who should check first 5

Situation	Advice	Evidence
Pregnancy and breastfeeding	NCCIH says peppermint in food amounts is likely safe, but little is known about medicinal amounts in pregnancy and breastfeeding. No pregnancy data were read for the other approaches here, so talk to your clinician first.	Health agency guidance ²⁰
Children and infants	NCCIH says menthol should not be inhaled by, or applied to the face of, infants or young children, as it may affect breathing. It also says premature infants have had serious infections with probiotics. Discuss peppermint oil capsules and probiotics with a paediatric clinician before giving them to a child.	Health agency guidance ^{20 21}
Weakened immune system or serious illness (probiotics)	NCCIH says anyone with a serious underlying condition should be monitored closely if taking probiotics.	Health agency guidance ²¹
Eating disorder, malnutrition risk or food insecurity	The AGA update names these as reasons to avoid restrictive diets and advises screening for disordered eating.	Guideline ⁵
Heartburn or reflux	NCCIH says peppermint oil taken alone may worsen indigestion in some people. Mention reflux symptoms to your clinician before using it.	Health agency guidance ²⁰

Overdose, product quality and regulators

Body	Action	Date
American College of Gastroenterology (ACG) (United States)	2021 guideline suggests a positive diagnostic strategy, celiac blood tests and fecal calprotectin where relevant, a limited low-FODMAP trial and gut-directed psychotherapy. source	2021-01
British Society of Gastroenterology (BSG) (United Kingdom)	2021 guideline classes IBS as a disorder of gut-brain interaction and grades recommendations for diet, drug and psychological therapies. Individual recommendations were not in the abstract. source	2021
American Gastroenterological Association (AGA) (United States)	2022 clinical practice update: soluble fibre efficacious, low-FODMAP the most evidence-based diet, gluten-free trial results mixed; cautions for restrictive diets. source	2022
National Center for Complementary and Integrative Health (NCCIH, US NIH) (United States)	Says a small body of research, mainly on enteric-coated capsules, suggests peppermint oil may improve IBS symptoms; probiotics page (2019) says no strain-level conclusions can be drawn. source	2025-05 (peppermint); 2019-08 (probiotics)
NHS (UK) (United Kingdom)	Lists symptoms and the signs that call for an urgent GP appointment or NHS 111. source	2025-03

When to get medical help

Blood in your stool, black or very dark stools, or bloody diarrhoea: request an urgent appointment or contact your local urgent care line (in the UK, NHS 111). For heavy, non-stop bleeding or large clots, use your local emergency number or go to the nearest emergency department.
Unexplained weight loss, a hard lump or swelling in the belly, or unusual tiredness, breathlessness or pale skin: see a doctor promptly, as these can be signs of something other than IBS.
A new or changing bowel pattern, or symptoms lasting more than 4 weeks without a diagnosis: book a doctor visit, as the NHS advises.
Severe or constant belly pain, or pain that wakes you at night: see a doctor promptly. NIDDK and the NHS do not list this exact sign, so treat it as general safety guidance.
Fever, repeated vomiting or being unable to keep fluids down alongside bowel symptoms: seek medical care. This is general safety guidance, not taken from a single source read.

Stop using the product and contact a clinician or emergency service. In the US, Poison Control is 1-800-222-1222.

General information only, not medical advice. Ask a clinician or pharmacist before use, especially with medicines, in pregnancy or with a health condition. See the Natural Remedy Safety guide.

Frequently asked questions

What is irritable bowel syndrome (IBS)?

IBS is a group of symptoms that occur together: recurring belly pain and changes in bowel movements, which may be diarrhoea, constipation or both, with no visible sign of damage or disease in the digestive tract. Doctors now call it a disorder of gut-brain interaction.

^{24 17}

What are the symptoms of IBS?

Belly pain or cramps that are often eased by a bowel movement, bloating, diarrhoea, constipation, a feeling that a bowel movement is incomplete, and sometimes whitish mucus in the stool. Symptoms come and go.

^{27 23}

What causes IBS?

The cause is unknown. NIDDK says a mix of factors is thought to be involved, including gut-brain interaction, early-life stress, anxiety or depression, gut infections, small intestinal bacterial overgrowth, food intolerances and genes.

²⁷

How is IBS diagnosed?

Mostly by symptom pattern: belly pain with two or more of pain linked to bowel movements, a change in how often you go and a change in stool appearance, for at least once a week over 3 months. Tests are used to rule out other conditions.

^{25 10}

How is IBS different from IBD and celiac disease?

IBS has no visible damage to the gut. Inflammatory bowel disease involves immune-driven inflammation and can cause bleeding and weight loss. Celiac disease is an immune reaction to gluten; about 6 percent of people with IBS had positive celiac blood tests in a 2025 review.

^{24 13 10}

Does the low-FODMAP diet work for IBS?

It has the most evidence of any diet, and guidelines suggest a limited trial, ideally with a dietitian. Confidence in the evidence is low to moderate, and restriction should not run longer than 4 to 6 weeks before foods are reintroduced.

^{4 6 5 10}

Is fibre or psyllium good for IBS?

In a 2026 review, 52 percent responded to fibre versus 44 percent to placebo, with a clearer benefit for psyllium. Add fibre slowly to limit gas and bloating.

^{14 26}

Do probiotics help IBS?

Pooled trials suggest probiotics may lower symptom scores, but certainty is low and no strain or product has been shown to be the one that works. People with weakened immune systems should ask a clinician first.

^{15 21}

Does peppermint oil help IBS?

Enteric-coated peppermint oil capsules beat placebo for overall symptoms and belly pain in pooled trials, but side effects such as heartburn were more common and the evidence quality is very low.

^{9 20}

Do CBT or hypnotherapy help IBS?

Yes, in trials. CBT and gut-directed hypnotherapy helped more people than waiting-list or routine care, and guidelines suggest gut-directed psychotherapy, though confidence in the evidence is low.

^{16 3 10}

Should I go gluten-free for IBS?

Trials are mixed and the two small ones read gave no clear benefit. The ACG guideline suggests celiac blood tests in IBS with diarrhoea, so ask a clinician before starting a gluten-free diet on your own.

^{7 5 13}

When should I see a doctor about IBS symptoms?

If symptoms have lasted more than 4 weeks, or at any time for blood in the stool, black stools, unexplained weight loss, a lump in the belly, or severe or constant pain. Do not assume these are IBS.

^{23 25}

Explore by health goal

Gut Digestive Health

Editorial transparency

Written by: AlternativeMed editorial team. Research compiled with AI assistance, then checked against PubMed records.
Medical review: None. This page has not been reviewed by a physician or pharmacist.
First published: 2026-10-31
Last substantive update: 2026-10-31
How we research: We searched PubMed, re-read the abstract of every review and trial cited, and read the NIDDK, NCCIH and NHS pages through a tool that summarises pages. Full texts were not read. Certainty ratings are the compiler's own reading, except where a guideline gives its own grade (stated in the text). Funding is not stated in most abstracts, and this is noted where relevant.
How we rate evidence: See "How we rate evidence" in the Evidence tab.
Independence: No product is promoted on this page. No affiliate links are shown.

Sources 28

Each source was opened and checked. Where we read only the abstract, it says so. The small numbers in the text point here.

Baboş CI, Leucuța DC, Dumitrascu DL. Meditation and Irritable Bowel Syndrome, a Systematic Review and Meta-Analysis.. J Clin Med. 2022. PMID 36362745. DOI 10.3390/jcm11216516. (abstract)
Black CJ, Yuan Y, Selinger CP et al. Efficacy of soluble fibre, antispasmodic drugs, and gut-brain neuromodulators in irritable bowel syndrome: a systematic review and network meta-analysis.. Lancet Gastroenterol Hepatol. 2020. PMID 31859183. DOI 10.1016/S2468-1253(19)30324-3. (abstract)
Black CJ, Thakur ER, Houghton LA et al. Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis.. Gut. 2020. PMID 32276950. DOI 10.1136/gutjnl-2020-321191. (abstract)
Black CJ, Staudacher HM, Ford AC et al. Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis.. Gut. 2022. PMID 34376515. DOI 10.1136/gutjnl-2021-325214. (abstract)
Chey WD, Hashash JG, Manning L et al. AGA Clinical Practice Update on the Role of Diet in Irritable Bowel Syndrome: Expert Review.. Gastroenterology. 2022. PMID 35337654. DOI 10.1053/j.gastro.2021.12.248. (abstract)
Cuffe MS, Staudacher HM, Aziz I et al. Efficacy of dietary interventions in irritable bowel syndrome: a systematic review and network meta-analysis.. Lancet Gastroenterol Hepatol. 2025. PMID 40258374. DOI 10.1016/S2468-1253(25)00054-8. (abstract)
Dionne J, Ford AC, Yuan Y et al. A Systematic Review and Meta-Analysis Evaluating the Efficacy of a Gluten-Free Diet and a Low FODMAPs Diet in Treating Symptoms of Irritable Bowel Syndrome.. Am J Gastroenterol. 2018. PMID 30046155. DOI 10.1038/s41395-018-0195-4. (abstract)
Goodoory VC, Khasawneh M, Thakur ER et al. Effect of Brain-Gut Behavioral Treatments on Abdominal Pain in Irritable Bowel Syndrome: Systematic Review and Network Meta-Analysis.. Gastroenterology. 2024. PMID 38777133. DOI 10.1053/j.gastro.2024.05.010. (abstract)
Ingrosso MR, Ianiro G, Nee J et al. Systematic review and meta-analysis: efficacy of peppermint oil in irritable bowel syndrome.. Aliment Pharmacol Ther. 2022. PMID 35942669. DOI 10.1111/apt.17179. (abstract)
Lacy BE, Pimentel M, Brenner DM et al. ACG Clinical Guideline: Management of Irritable Bowel Syndrome.. Am J Gastroenterol. 2021. PMID 33315591. DOI 10.14309/ajg.0000000000001036. (abstract)
Meyer A, Auer J, Cascant-Ortolano L et al. Systematic Review and Meta-Analysis: Plant-Based Therapy for Irritable Bowel Syndrome.. Phytother Res. 2026. PMID 42572206. DOI 10.1002/ptr.70421. (abstract)
Saab O, Al-Obaidi H, Algodi M et al. Yoga for Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.. Am J Gastroenterol. 2025. PMID 40358469. DOI 10.14309/ajg.0000000000003524. (abstract)
Shiha MG, Schiepatti A, Manza F et al. Global Prevalence of Celiac Disease in Patients With Rome III and Rome IV Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis.. Am J Gastroenterol. 2025. PMID 40493044. DOI 10.14309/ajg.0000000000003586. (abstract)
Staudacher HM, Rucco V, Mancell S et al. Fiber Supplementation in Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.. Gastroenterology. 2026. PMID 42600900. DOI 10.1053/j.gastro.2026.07.027. (abstract)
Tang ASP, Quek J, Sulaimi F et al. Probiotics for Irritable Bowel Syndrome: An Updated Systematic Review and Meta-Analysis With Trial Sequential Analysis.. J Gastroenterol Hepatol. 2026. PMID 41820241. DOI 10.1111/jgh.70322. (abstract)
Thakur ER, Khasawneh M, Moayyedi P et al. Efficacy of behavioural therapies for irritable bowel syndrome: a systematic review and network meta-analysis.. Lancet Gastroenterol Hepatol. 2025. PMID 41077057. DOI 10.1016/S2468-1253(25)00238-9. (abstract)
Vasant DH, Paine PA, Black CJ et al. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome.. Gut. 2021. PMID 33903147. DOI 10.1136/gutjnl-2021-324598. (abstract)
Wu J, Du S, Sun Y et al. Evaluation of the effectiveness of exercise therapy for irritable bowel syndrome: a systematic review and meta-analysis.. Front Med (Lausanne). 2026. PMID 41884124. DOI 10.3389/fmed.2026.1771521. (abstract)
Zheng HZ, Zou HL, Chen BH et al. Acupuncture Versus Sham Non-Acupoint Acupuncture for Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis.. Gastroenterology. 2026. PMID 42413705. DOI 10.1053/j.gastro.2026.06.017. (abstract)
. NCCIH: Peppermint oil (last updated May 2025). . . (full-text)
. NCCIH: Probiotics, usefulness and safety (last updated August 2019). . . (full-text)
. NHS: Bowel cancer, symptoms (reviewed 4 September 2026). . . (full-text)
. NHS: Irritable bowel syndrome (IBS), symptoms (reviewed 17 March 2025). . . (full-text)
. NIDDK: Definition and facts for irritable bowel syndrome (last reviewed November 2017). . . (full-text)
. NIDDK: Diagnosis of irritable bowel syndrome (last reviewed November 2017). . . (full-text)
. NIDDK: Eating, diet and nutrition for irritable bowel syndrome (last reviewed November 2017). . . (full-text)
. NIDDK: Symptoms and causes of irritable bowel syndrome (last reviewed November 2017). . . (full-text)
. NIDDK: Treatment for irritable bowel syndrome (last reviewed November 2017). . . (full-text)

Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.