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Irritable bowel syndrome (IBS) is the commonest condition seen in gastroenterological practice and affects about 15% of the population of Western countries and probably a similar proportion in Asia. Its aetiology (underlying cause of disease) and pathogenesis (organisms causing the disease) are not well understood, although there is developing consensus that altered bowel motility, visceral hypersensitivity and psychosocial factors all contribute to the symptoms through pathways regulated by serotonin and other enteric nervous system neurotransmitters.

Additionally , in the postinfectious form of irritable bowel syndrome, a number of recent studies have reported a persisting subtle inflammation of the colonic mucosa. The diagnosis is based on the modified Rome criteria: the presence of at least 12 weeks (not necessarily consecutive) in the preceding 12 months of unexplained abdominal discomfort or pain with at least 2 of the following 3 features:
(a) pain is relieved by defecation
(b) onset of pain is linked with a change in bowel frequency - either diarrhea or constipation
(c) onset of pain is linked with a change in appearance of stool - watery, loose or pellet-like

Individuals with irritable bowel syndrome often experience urgency, straining, tenesmus, abdominal bloating or passage of mucus and have an increased prevalence of other disorders such as nonulcer dyspepsia and oesophageal dysmotility, urinary frequency, headaches, dysmenorrhoea, dyspareunia and fibromyalgia.

Some patients with irritable bowel syndrome have associated depression or anxiety, and the recognition of successful treatment of these conditions may lead to resolution of their abdominal symptoms.

Other important clinical signs and symptoms of irritable bowel syndrome include abnormality on examination of abdomen, anemia, fever, nocturnal diarrhea, persistent mouth ulcers, rectal bleeding, significant weight loss, steatorrhea, vomiting and severe pain. Risk factors that may lead to these symptoms include any family history of bowel cancer, coeliac disease or inflammatory bowel disease; as well as if the age of onset if more than 40 years.

Some food components may contribute to the symptoms of irritable bowel syndrome. Many patients report to their medical practitioner that they notice onset of symptoms after eating specific foods. Conversely, many patients report that they are chronically unwell and are unable to identify any specific food and symptom relationship. An alternative to pharmacological

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