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Patients with IBS had a nearly three-fold increased odds of RLS compared with controls (OR=2.60, 95%CI 2.17-3.12, P0.00001; I =48%, P=0.11). Three sensitivity analyses confirmed the robustness of the pooled result. Two cross-sectional studies involving 3581 individuals met the criteria of RLS predicating the onset of IBS. RLS patients had a nearly four-fold increased odds of IBS compared with controls without RLS (OR=3.87, 95%CI 1.73-8.66, P=0.0010; I =77%, P=0.04). In this systematic review and meta-analysis, we found a substantial bidirectiona