OBJECTIVES: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder. We assessed utilisation of secondary care services and associated costs among patients with IBS. METHODS: IBS was identified by medical diagnosis and/or prescribing in the UK primary care setting. Patients had ≥12 months of medical history prior to diagnosis. Absolute resource use and expenditure were assessed post IBS and over four years (01/04/2008-31/03/2012) using Hospital Episode Statistic data. Inpatient admission, outpatient attendance and length of stay for any cause including IBS related conditions were assessed. Inpatient costs for the period were estimated using allocated Health Resource Group coded data. Outpatient costs were estimated using national average reference costs based on treatment speciality. Costs of medications prescribed in secondary care were not included. Total, mean and annual visits and costs were estimated and stratified by gender, age and treatment speciality. Prices were adjusted to 2011/2012. RESULTS: We identified 79,303 patients with IBS with an average follow-up of 3.38 years. Of these patients, 46,814(59%) had ≥1 contact with secondary care for any cause; 22,685(48.5%) patients attended outpatient services only. Patients using secondary care had about 2 hospitalizations on average and 3-4 outpatient visits annually. Mean inpatient stay declined from 4 days in 2008/2009 to 3 days in 2011/2012. The total cost of hospitalisation during the period was over £114 million, including about £35(30%) million for emergency inpatient admissions and £33.8 million for outpatient attendance. Digestive disorders accounted for around 30% of inpatient admissions and 21% of expenditure incurred. Mean cost of inpatient admissions for digestive conditions was £1,993, average costs per patient was £4,871 and £2,779 for elective and emergency visits respectively. CONCLUSIONS: Utilisation and costs of secondary care among IBS patients is substantial, not only for the management of IBS and related conditions, but also for other co-morbid medical conditions.