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. 2021 Feb 4;56(3):193–217. doi: 10.1007/s00535-020-01746-z

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© The Author(s) 2020

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 4 — Step 3 of the IBS Therapeutic Algorithm. Severe IBS patients who do not respond to conventional pharmacotherapy are treated in this step. See the main text for further details. Gastrointestinal dysfunction can be determined with gastrointestinal transit study, anorectal manometry, colonic manometry, or colorectal barostat examination