Which IBS is better

Better grasp the suffering of irritable bowel syndrome


Patients with irritable bowel syndrome (IBS) often experience their illness as very stressful and feel restricted in their quality of life due to the recurring abdominal pain, gas and / or stool irregularities. Unfortunately, the importance of this “burden” is often underestimated in practice, even though it has a decisive influence on the success of the treatment.

In the last 20 years, various IBS-specific measuring instruments have been developed to make this sensation measurable and to check the treatment success of the examined intervention. We present two well-known and frequently used scores here.

Record the severity of the disease in irritable bowel syndrome

The Irritable Bowel Syndrome - Severity Scoring System (IBS-SSS for short) is a questionnaire that is used to record or assess the severity of the disease - especially in studies. This was developed by Francis et al. Validated for the first time in 1997 [Fra 1997].

The questionnaire consists of two parts:

  • Part 1 comprises 5 questions in which the patients rate the severity and frequency of pain, the extent of flatulence, satisfaction with bowel movements and the perceived impairment of quality of life in the last 10 days on a scale from 0 to 100. The number of points for the individual questions is added, so that theoretically a maximum value of 500 can be achieved. The total number of points represents the test result (score) and is intended to reflect the severity of the disease.
  • Part 2 contains questions about bowel movements, the localization of the pain felt and the number of days absent due to illness, but is not included in the calculation of the test result.

Interpretation of IBS severity (according to [Fra 1997])

75 to <175 mild
175 to 300 moderate
 >300 heavy

Record impairment of quality of life in irritable bowel syndrome

The extent to which the quality of life in irritable bowel syndrome is impaired by the disease or the associated symptoms is assessed with the help of the Irritable Bowel Syndrome Quality of Life (IBS-QOL for short) questionnaire. This measuring instrument is also primarily used in studies and is considered to be very reliable. The IBS-QOL was developed in the 1990s by an American research team in collaboration with Novartis Pharmaceuticals Corporation and Novartis Pharma AG.

The test consists of a total of 34 questions. For example, the patient provides information about his or her physical, emotional or psychological feelings, social relationships and interactions as well as everyday functionality.

The patient's quality of life is assessed on the basis of the number of points achieved. The more points the respondent scores, the higher the quality of life is assessed.


The IBS-SSS criticizes the fact that the questions reflect too much the “doctor's point of view” of the individual factors and less the severity of the symptoms perceived by the patient himself. This seems to be much more related to how much the symptoms affect daily life. In fact, it can be observed in practice that those affected rate their symptoms and the loss of quality of life as more serious than those around them or the doctors treating them. However, there is still no generally applicable definition of the severity of IBS.

Relevance to nutritional therapy

When irritable bowel patients come to counseling, they sometimes have a long history of suffering behind them. It is not uncommon for them to find that their complaints are not taken seriously enough and are disappointed or even frustrated. The task of the advisor at this point could not only be to accompany the change in diet and to find possible symptom triggers. It can also be advantageous to take the patient's subjective feeling into account. In addition to a detailed anamnesis, specific questions can provide insight into the burden of disease felt by the patient.

The questionnaires presented cannot be easily applied in practice, but they provide valuable suggestions for nutritional therapy.