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Make detailed notes for irritable bowel syndrome. Explain in detail and in chronological order based on the document: its definition, ethology, pathophysiology, clinical approach, signs and symptoms (with pathophysiology), investigations (with expected outcomes from the investigation), management, and complications (with pathophysiology)

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Structure of the Notes:
  1. Definition — Functional bowel disorder, no organic lesion, Rome IV update
  2. Epidemiology — Prevalence figures, sex ratios, socioeconomic burden
  3. Aetiology — The full biopsychosocial model: psychosocial triggers, physiological/genetic factors (serotonin, SERT/TPH1 polymorphisms, twin studies), luminal factors (dysbiosis, SIBO, bile acid malabsorption, FODMAPs, gluten sensitivity), and specific onset triggers
  4. Pathophysiology — Eight detailed mechanisms: motor abnormalities, visceral hypersensitivity, CNS dysregulation (fMRI evidence), psychological features, post-infectious IBS (with risk factors), immune activation/mast cells/TRPV1/leaky gut, gut dysbiosis mechanisms (organism-specific), and serotonin pathway abnormalities
  5. Clinical Approach — Features supporting and against IBS, differential diagnosis by pain location, factors determining investigation aggressiveness
  6. Signs & Symptoms with pathophysiology — Abdominal pain, altered bowel habits (with subtype table), gas/bloating, mucus, upper GI symptoms, and the full list of extraintestinal symptoms
  7. Investigations with expected outcomes — Full table of every test, its purpose, and what to expect in IBS vs. organic disease
  8. Management — Severity-stratified; all dietary, pharmacological (with mechanisms and doses from the drug table), gut flora modulation, and psychological interventions
  9. Complications with pathophysiology — QoL impairment, psychiatric comorbidity (with the anxiety cycle), extra-GI complications (fibromyalgia, CFS, TMJ — with shared pathophysiology), nutritional risks, narcotic danger, drug-specific complications, and missed diagnosis risk
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