Share ThisEditor’s Update: This article was first published May 31, 2023. It was most recently reviewed and updated April 3, 2025. You can also check out Dr. Javed's 2025 bylined article separating IBS facts from fallacies.
In our Ask a Doc series, we sit down with physicians and other clinical experts, including those at Allegheny Health Network (AHN), for a chat on an important health topic. In this interview, we talk with Dr. Saad Javed, a gastroenterologist at the AHN Medicine Institute, about irritable bowel syndrome.
Irritable bowel syndrome (IBS) is one of the most commonly diagnosed digestive conditions, estimated to impact at least 10-15% of the U.S. population and accounting for between 20% and 50% of referrals to gastroenterologists. Unfortunately, only about 30% of people experiencing symptoms of IBS will seek medical help.
Saad Javed, MD, a GI-motility and neurogastroenterology specialist with AHN Medicine Institute, emphasizes that no one should just suffer with symptoms. While every individual is different, he says it is usually possible to find an effective IBS treatment and management approach that significantly improves quality of life. I spoke with Dr. Javed to learn more about IBS.
Megha Pai: Let’s start by learning a little about your field. Can you tell us a bit more about the specialties of motility and neurogastroenterology, for those who may not be familiar? And what was your motivation in pursuing this field?
Dr. Saad Javed: Broadly speaking, any alteration in the transit of gastrointestinal (GI) contents and secretions can be considered a motility disorder. But no matter the cause, the result is a loss of coordinated muscular activity in the digestive system. This leads to movement of food or stool that’s either too fast or too slow.
The symptoms attributed to suspected motility disorders can include difficulty swallowing, bloating, nausea, vomiting, chronic constipation, irritable bowel syndrome (IBS), abdominal pain, acid reflux and incontinence.
Our brain and gut are very deeply, richly interconnected. The dysfunction of this integral gut-brain axis is what the field of neurogastroenterology deals with specifically.
Working in motility and neurogastroenterology allows me to engage in a very holistic approach to help improve the symptoms of debilitating dysmotility and, if possible, resolve the root cause — enhancing patients’ quality of life, sense of well-being and capacity to engage in everyday activities. It’s challenging, but also deeply gratifying.
Megha Pai: What exactly is IBS?
Dr. Saad Javed: IBS is a GI disorder characterized by chronic abdominal pain and altered bowel habits in the absence of structural or anatomical causes. The Rome Foundation — a multinational group of scientists and clinicians — defines the criteria for an IBS diagnosis as recurrent abdominal pain at least one day a week in the last three months that’s linked to defecation, or change in the frequency or appearance of bowel movements. IBS usually manifests with constipation or diarrhea.
Megha Pai: What are the differences between IBS and inflammatory bowel disease (IBD)?
Dr. Saad Javed: Although IBS and IBD share similar symptoms, they’re very distinct digestive disorders that require very different treatments.
IBD includes chronic inflammatory diseases involving the GI tract, like Crohn’s disease and ulcerative colitis — where immune cells cause inflammation and ulceration in the lining of the intestines, which can lead to frequent and/or urgent bowel movements, abdominal pain, diarrhea, or bleeding. Symptoms depend on where the inflammation is located in the GI tract.
Some patients with IBD can develop overlapping IBS features, due to chronic persistent inflammation. So neurogastroenterologists may be involved in the care of complex IBD patients.
Megha Pai: There seems to be some debate on what causes irritable bowel syndrome. Can you talk about the factors involved?
Dr. Saad Javed: Despite extensive research, a clear, unifying cause for IBS is still not evident. There are many theories about how and why IBS develops.
Some symptoms may be precipitated by abnormal motility or spasms — uncontrolled contractions in the muscles of the gut. This may explain why certain IBS treatment approaches, such as antispasmodic medications and fiber (both of which help regulate the contractions of the colon), can relieve symptoms.
Many recent studies have revealed that a major component could be visceral hyperalgesia or hypersensitivity, which is heightened sensitivity of the nerves supplying the intestines. The thinking is that nerve-endings in the gut perceive and relay excessive and painful signals to otherwise normal stimuli like gas or stool in the gut. That is why some patients with severe IBS feel better when treated with neuromodulators — medications that decrease pain perception in the intestine.
Some people with predominantly diarrheal or bloating symptoms may also have a condition called small intestinal bacterial overgrowth (SIBO), where there’s a surplus of bacteria in the small intestines. While it’s unclear whether SIBO can be a cause of IBS, those with IBS are more likely than others to test positive for SIBO. This means that IBS symptoms may respond after antibiotic treatment that focuses on bacteria in the small intestine.
Anxiety, sleep problems and phobias have also been shown to be independent risk factors for the development of IBS. Additionally, food intolerances, recent infections or exposure to antibiotics, and inflammatory processes in the wall of the gut and genetics have all been implicated in the genesis of IBS.
Megha Pai: Tell us about the subtypes of IBS, and why those labels are important.
Dr. Saad Javed: IBS is characterized by four distinct subtypes: IBS-D (with diarrhea-predominant symptoms), IBS-C (with constipation-predominant symptoms), IBS-M (mixed symptoms), and those without a significant pattern of abnormal stool (IBS-U). Understandably, the management and therapeutic options are aimed at the over-arching symptoms. But this is not just about labels. We know that providing IBS patients with a clear, confident and precise diagnosis translates into less demand for additional diagnostic workup. Multiple studies have established that categorizing patients based on an accurate IBS-subtype improves patient therapy and outcomes.
Megha Pai: Does the varied pathophysiology also reflect how IBS is managed?
Dr. Saad Javed: Absolutely. Every patient is unique and each patient warrants and deserves a compassionate, individualized strategy. Finding a plan that works can take time and experimentation, but we have a whole team dedicated to the cause. We often start with the easiest and safest steps, like dietary changes. We sometimes use integrative ideas like natural and herbal remedies, and then move on to medications aimed at reducing pain and alleviating diarrhea or constipation. It’s common to try more than one combination of treatments before we find the one that’s most helpful, yet still has the least amount of side effects.
Megha Pai: And that would also be why a coordinated, multidisciplinary care approach like AHN’s is important in helping patients with IBS?
Dr. Saad Javed: Indeed. IBS is a chronic, lifelong condition. The burden of chronic pain takes a toll on minds and bodies alike. AHN’s approach is to bring the right care-providers together within a variety of evidence-based pathways to help patients navigate these challenges.
For example, we encourage patients to always have an open discussion with their health care providers about the role that stress, depression and anxiety could have on their symptoms, so they can decide the best course of action together. Our Chronic Condition Specialty Team includes dedicated behavioral health specialists, dieticians and pharmacists that work closely with the patient — with coordination by a skilled nurse navigator — to address nutritional interventions and psychological coping mechanisms. I also work closely with our Enhanced Pain Management Program, which uses methods like acupuncture, medical massage, cognitive behavioral therapy, medical marijuana and more novel pain management approaches.
We’re also working with AHN Behavioral Health Associates to embed the Empowered Relief program into our clinical pathway. This is an evidence-based, single-session pain class that rapidly equips patients with pain management skills.
Megha Pai: Before our interview, you brought up the importance of addressing barriers to GI care that women encounter. We’d like to do a whole article on that eventually, but for now, can you talk about some specific ways that digestive diseases in general, but IBS in particular, impact women?
Dr. Saad Javed: Overall, IBS has higher prevalence in women than in men. Female patients may also be more likely to have constipation-predominant IBS, compared to males. Additionally, certain coexisting conditions might make managing IBS more challenging for women — including fibromyalgia, chronic fatigue syndrome, functional dyspepsia, and psychiatric disorders like depression, anxiety, and somatization. There are multiple reasons why women may be more impacted by GI issues than men. Factors like the menstrual cycle, hormonal changes throughout a woman’s lifetime, pregnancy, childbirth and menopause can all impact GI symptoms. Stigma around gut health is definitely a factor in terms of barriers to care for any women’s digestive disorders.
Let’s not forget that the uterus and ovaries are very close to the colon and small intestine. So, for female patients who have had surgeries in the pelvic region — including cesarean sections, ovarian surgery and hysterectomies — it is common to develop digestive issues. Health care providers need to remember that this can all contribute to GI symptoms, including abdominal pain, constipation, lack of bowel control, hemorrhoids and pelvic organ prolapse.
While we’re discussing the burden of digestive illnesses in female population, a reminder that according to the American Cancer Society, more than 70,000 women in the U.S. each year learn they have colorectal cancer. It’s the third most common cancer in women (and men). We’re also curious about familial colon cancer syndromes that can be associated with uterine, ovarian and breast cancers. In addition, the female colon is often more challenging to scope due to the anatomically deeper pelvis, increased prevalence of scar tissue from prior pelvic surgeries.
For all these reasons, it is important to find a health care provider who is cognizant of the issues specific to women. I also encourage female patients to never feel uncomfortable requesting a female provider, if they prefer one.
Megha Pai: How has diagnosis and treatment of IBS improved over the years, and where do you think the biggest improvements in the field will be in the years ahead?
Dr. Saad Javed: Our understanding of this condition is rapidly evolving. There was a time when any and all digestive symptoms without a clear cause were labeled as IBS. But this is no longer the case.
Advancements and better insights have led to newer guidelines from GI societies, which has helped streamline how gastroenterologists approach IBS. I’m excited about the new data regarding gut-directed psychotherapies, like cognitive behavioral therapy and hypnotherapy. The use of these methods, in addition to dietary modifications and pharmaceuticals, is now recommended to treat IBS symptoms overall.
The treatment of visceral pain continues to be investigated. Hopefully, studies emerging over the next few years will reveal agents that can better help improve pain outcomes. Similarly, we are optimistic that our understanding of the role of intestinal permeability and microscopic inflammation in the generation of IBS symptoms will improve dramatically soon.
Saad Javed, MD, is a gastroenterologist with AHN Medicine Institute, specializing in the diagnosis and treatment of diseases and problems of the gastrointestinal tract. His clinical interests center on functional and motility disorders of the GI tract, including chronic abdominal pain and IBS.
He went to medical school at King Edward Medical University in Lahore, Pakistan. He did his residency in internal medicine and his fellowship in gastroenterology at Lahey Clinic in Burlington, Massachusetts. Dr. Javed completed his advanced fellowship in neurogastroenterology and motility at the University of Pennsylvania in Philadelphia, Pennsylvania.
Dr. Javed is certified by the American Board of Internal Medicine. He is affiliated with the American College of Gastroenterology, the American Neurogastroenterology and Motility Society, and the American Gastroenterological Association. Dr. Javed speaks English, Urdu, Punjabi, and Hindi and sees patients ages 18 and older.
Dr. Javed strives to provide compassionate and conscientious care to each patient; all the while working together, with the patients and colleagues from different specialties, in a collaborative and communicative spirit. Outside of the office, you can find Dr. Javed hiking, baking, reading to his young son and volunteering at the local animal shelter.
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