It has been suggested that the annual direct costs for irritable bowel syndrome (IBS) are now around $US41 billion in the 8 most industrialised countries. This paper reviews the data on calculations of direct costs. The true economic burden is unclear, as there are insufficient data on indirect costs other than absenteeism from work and intangible costs cannot be estimated, particularly since presenters with IBS constitute only a subset of the patients with such symptoms in the community. Strategies to reduce direct costs must include physician and patient education, paramedical-based education and therapy, lay support groups, early consideration of psychosocial issues and psychological treatments, avoidance of unnecessary investigations and optimising the doctor-patient relationship. Indirect and intangible costs could be effectively reduced by novel, effective (not only efficacious) therapies.