Introduction:
Irritable Bowel Syndrome (IBS) is a gastrointestinal disorder commonly affecting 11% of the population, mainly women (2:1) under 50 years.
It usually manifests itself as intermittent pain with tolerable to severe intensity becoming disabling thus reducing quality of life (QoL); also, this pain overlaps other gastrointestinal disorders (functional dyspepsia, nausea, constipation due to pelvic floor dyssynergia, Crohns, etc.).
The multifactorial pathophysiology mechanism (Fig. 1) is very complex although recent scientific evidence highlights the importance of gut dysfunction and visceral sensation considering they are closely related to the HPA axis (hypothalamus–pituitary–adrenal due to its sensorimotor functions), the brain–gut axis and the enteric nervous system (ENS). It is challenging for both patients and the actual evidence based medicine (EBM) to identify the IBS’s etiology.

Objectives:
The aim is to critically evaluate the evidence of osteopathic manipulation (OMT) on the severity of IBS symptoms (IBS-severity score: pain, quality of life, etc.) in order to be considered feasible and realistic as complementary and alternative medicine (CAM).

Methodology:
A systematic review has been conducted, screening and reviewing more than 10 among databases and journals to answer the aim.

Results:
All studies reflect a significant improvement in IBS severity score and pain level (p ≤ 0.01).

Conclusions:
OMT could be considered feasible and realistic as complementary and alternative medicine (CAM). 
Further investigations are needed in this area to allow meta-analysis and to demonstrate how osteopathy can act holistically (Fig.2) on IBS (on musculoskeletal system, the ENS, the ANS and the neuroendocrine system) and affirms itself as desirable and achievable.

EFFECTIVENESS OF OSTEOPATHIC MANIPULATION TO CRITICALLY EVALUATE SEVERITY SYMPTOMS IN IRRITABLE BOWEL SYNDROME - IBS