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IBS symptoms and quality of life 51 3 Introduction Irritable Bowel Syndrome (IBS) is a brain-gut-disorder characterized by a chronic relapsing-remitting nature of symptoms, including abdominal pain and altered bowel habits. Global prevalence, based predominantly on the Rome III criteria, is estimated at 5-20% 1 , with varying rates according to geographical area and diagnostic criteria used. 2 Recent studies using the more restrictive Rome IV criteria point to lower prevalence rates of 5-6%. 3,4 Although the exact pathophysiology of IBS remains incompletely understood, a multifactorial origin is generally recognized, in which dysregulation of the brain-gut-axis has a central role. Other factors include aberrant neuroimmune interactions, visceral hypersensitivity, genetic susceptibility, microbiome alterations, and psychosocial factors. 5,6 As interference of IBS with patients’ everyday lives is extensive 7 and treatment results are often unsatisfactory, quality of life is low and comparable to chronic somatic diseases. 8 Given the heterogeneous nature of the disorder, symptom patterns vary widely both between and within IBS patients and predicting individual disease courses remains challenging. IBS is known as a chronic, in many patients lifelong, condition with fluctuating gastrointestinal (GI) symptoms. Symptoms such as abdominal pain, constipation, and diarrhea are known to occur in episodes of several days followed by days without symptoms. 9 In addition, transitions from one predominant bowel habit type to the other are common and occur in up to 75% of patients. 10-12 Quality of life, on the other hand, has been shown to be relatively stable over a three-month period. 13 With regard to long-term symptom variability, several studies have investigated the disease course of IBS and have shown varying results with respect to symptom severity and quality of life. The majority of the prospective studies had a follow-up period of approximately one year, which is relatively short for a condition such as IBS. In addition, there is a lack of follow-up data for the Dutch population. As implications of IBS on quality of life have shown to vary considerably between different countries 14 , it is of added value to expand earlier findings and investigate the natural history of IBS in a Dutch, well-characterized population. Finally, as IBS is a symptom-based diagnosis, it is of interest to assess how symptoms evolve over time and how these symptoms and long-term quality of life relate to the Rome diagnostic criteria for IBS, in particular when they are confirmed in a telephonic interview rather than a purely survey-based assessment at follow-up measurements.