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We sought to test the effectiveness of expressive writing about irritable bowel syndrome (IBS) on disease severity, IBS-related cognition (perceived control over the illness or adaptive cognition), and IBS-specific quality of life.This was an exploratory pilot study, during which subjects with IBS were asked to write at an online portal for 30 min on 4 consecutive days about their deepest thoughts, emotions, and beliefs regarding the disease and their perception of its effects (writing group). The IBS severity scale (IBSSS), functional bowel disease-related cognition (CG-FBD), catastrophizing/coping (CT3), and IBS-specific quality of life (IBS-QOL) were measured at baseline and at 1 and 3 months' follow-up. Subjects who did not start writing for 3 weeks were asked to complete questionnaires without writing (non-writers group). Within-group comparisons pre- and post-assessment were compared. In addition, the writing and non-writers groups were compared. Linear mixed-effects models were used to assess the outcome measures over time (1 and 3 months).A total of 103 subjects were enrolled in the study (writing group,n=82; non-writers group,n=21). The mean age of all participants was 43 years (s.d. ±12), and the majority (91%) were female. The mean duration of IBS was 6.8 years (s.d. ±3.5); 102 subjects (99‰) had received physician-directed care for the disease. There were no significant differences between the writing and non-writers groups in baseline measurements. For the writing group at 1 and 3 months, the IBSSS improved significantly (+37.4 (±10.8),P=0.0012 and +53.8 (±13),P=0.0002, respectively) and this was not seen in the non-writers group. Similarly, the CG-FBD improved in the writing group by 0.58 (±0.2,P=0.006) at 3 months, although the changes in IBS–QOL did not reach clinical or statistical significance.In this exploratory study, expressive writing improved IBS disease severity and cognition in subjects with longer-term duration of the disease. A large, controlled study is warranted to evaluate the therapeutic potential of this novel modality for adjunctive management of IBS in the outpatient setting.