In the modern era of medication, the pendulum swung the other way. Gastroenterologists now recognise that IBS is a real physiological, or “functional,” disorder, though no specific cause has been discovered.

Recent studies have implicated serotonin as one factor, since patients with IBS have reduced receptors for this chemical. And studies have shown that low levels of selective serotonin reuptake inhibitors can sometimes relieve its symptoms.

In many patients, symptoms can be set off by large meals or certain foods — wheat, rye, barley, chocolate, milk products, alcohol, coffee, tea and colas. By keeping a food diary and recording symptom flare-ups, patients can identify their sensitivities and avoid the culprit foods.

Reuniting mind and body

A small but growing number of specialists are seeking to reunite mind and body by treating patients with a combination of medication, dietary precautions and emotional re-education. Their early studies indicate that this mind-body approach is more effective than either alone.

Dr Charles D Gerson, a gastroenterologist affiliated with Mount Sinai Medical Center, works with his wife, Mary-Joan Gerson, a psychotherapist, and their daughter, Jessica, a hypnotherapist, at the Mind-Body Digestive Center in New York.

In an interview, Gerson said for patients who are seriously impaired by IBS, medication helps but “there is no magic pill that solves the whole problem. Patients need a more holistic approach. Those who accept emotional as well as physical causes of their condition do better.”

While it is destructive for patients with IBS to be told that it is all in their head, it is also wrong to ignore the psychosocial factors that play a role, he said. “I tell patients that if they don’t deal with the emotional factors that relate to their problem,” Gerson said, “they are likely to continue to have symptoms.”

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