Review ArticleNew insights into the pathogenesis and treatment of irritable bowel syndrome
Introduction
Irritable bowel syndrome (IBS) is one of the most common functional bowel disorders characterized by recurrent abdominal pain and change in bowel habits (constipation or/and diarrhoea). The symptoms occur at least 1 day per week in the last 3 months and should be associated with 2 or more of the following criteria: (1) related to defecation; (2) a change in the frequency of defecation; (3) a change of stool appearance [1].
The stool is assessed following the Bristol Stool Form Scale (BSFS), showing its 7 types: types 1 and 2 as constipation, 3 and 4 – normally formed stool of a healthy person, whereas types 5–7 correspond to diarrhoea [2].
According to the character of patient's stools assessed using BSFS, four types of IBS having comparable prevalence rates can be distinguished: IBS-D (diarrhoea-predominant), IBS-C (constipation-predominant), IBS-M (mixed, i.e. alternating diarrhoea and constipation) and IBS-U (unsubtyped) [2], [3]. The IBS-C may be diagnosed if more than 25% of bowel movements is type 1 or 2 and less than 25% – type 6 or 7. IBS-D criteria require more than 25% of bowel movements type 6 or 7 and less than 25% – type 1 or 2. Patients with IBS-M should demonstrate mixed bowel habits with more than 25% of bowel movements type 1 or 2 and more than 25% – type 6 or 7. IBS-U is diagnosed when patient bowel habits cannot be categorized to any of 3 groups above [1]. It is, however, worthy of note that in approximately 75% of patients, the type of IBS may undergo some changes in a relatively short time [3].
IBS is widespread in developed countries, although its prevalence increases worldwide and it is estimated at 9–23% in the overall population [4]. The morbidity rate in the adult population is 200/100,000 people/year [5]. In European countries and in the USA, the prevalence rate of IBS is 7–30% of the population [6], with women being more frequently affected (2:1) [4], [7], [8]. Most patients at the time of diagnosis are under 50 [3]. The prevalence of IBS in a group of children aged 4–18 years is 8.8% [9]. Despite high prevalence of IBS, its aetiology and pathogenesis have not been fully explained, and the diagnostics may be difficult in some cases.
The disease was first described in 1849, but the first holistic concept of mind and body integration and its’ inseparability was proposed by Plato, Aristotle and Hippocrates. The first physician who suggested emotional changes could lead to medical disease development was Claudius Galen. In 20th century an experiment performed by Tom Almy indeed confirmed correlations between mood and gastric motility [4], [10].
For a long time IBS was classified as a psychiatric disorder due to a very high incidence of psychological distress or disturbances in these patients. In the 1980s the first diagnostic criteria of IBS were published by an group of experts working on functional gastrointestinal disorders (FGID) [10]. Currently, the disease is diagnosed according to IV Rome Criteria [1].
In this review we summarize the diagnosis, main pathophysiological aspects and therapeutic management strategy of IBS.
Section snippets
Clinical symptoms and criteria of IBS diagnosis
Diagnostic principles of gastrointestinal tract dysfunctions are defined in Rome IV Diagnostic Criteria published in 2016. According to them, IBS can be diagnosed when a patient complains of recurrent abdominal pain associated with 2 or more of the following criteria: (1) related to defecation; (2) associated with a change in the frequency of defecation; (3) associated with a change of stool appearance (Table 1). There are some differences in diagnostic criteria of IBS in adults, children and
Conclusion
IBS is a disease entity of complex aetiology and despite numerous studies, there is still a lot of questions and doubts both on its definition, pathophysiology, diagnostic criteria and management. From the pathological point of view, the exact mechanisms of visceral sensitivity in IBS has not been clarified, yet. It is not known which mediators and pathways underly sensitization of nociceptors and visceral sensitivity are involved in specific patients. Also the role of gut microbiota,
Conflict of interests
The authors declare no conflict of interests.
Financial disclosure
None declared.
References (152)
- et al.
Functional bowel disorders
Gastroenterology
(2006) - et al.
Infection, inflammation, and the irritable bowel syndrome
Dig Liver Dis
(2009) - et al.
Childhood functional gastrointestinal disorders: child/adolescent
Gastroenterology
(2006) - et al.
Neuromodulatory processes of the brain-gut axis
Neuromodulation
(2008) - et al.
Fundamentals of neurogastroenterology: basic science
Gastroenterology
(2016) - et al.
Irritable bowel syndrome in female patients is associated with alterations in structural brain networks
Pain
(2014) - et al.
The effects of biofeedback on rectal sensation and distal colonic motility in patients with disorders of rectal evacuation: evidence of an inhibitory rectocolonic reflex in humans?
Am J Gastroenterol
(1999) - et al.
The receptor TGR5 mediates the prokinetic actions of intestinal bile acids and is required for normal defecation in mice
Gastroenterology
(2013) - et al.
Zespół jelita drażliwego u dzieci i młodzieży
Pediatr Pol
(2010) - et al.
Importance of epigenetic mechanisms in visceral pain induced by chronic water avoidance stress
Psychoneuroendocrinology
(2013)
Vagal afferent input from the acid-challenged rat stomach to the brainstem: enhancement by interleukin-1beta
Neuroscience
Increased IgA and IgM responses against gut commensals in chronic depression: further evidence for increased bacterial translocation or leaky gut
J Affect Disord
Neuropeptide Y, peptide YY and pancreatic polypeptide in the gut-brain axis
Neuropeptides
The role of diet in symptoms of irritable bowel syndrome in adults: a narrative review
J Am Diet Assoc
Food: the forgotten factor in the irritable bowel syndrome
Gastroenterol Clin North Am
Are adverse food reactions linked to irritable bowel syndrome?
Am J Gastroenterol
Milk intolerance and microbe-containing dairy foods
J Dairy Sci
A systematic review of neuroimaging data during visceral stimulation
Am J Gastroenterol
Bowel disorders
Gastroenterology
Irritable bowel syndrome: diagnosis and pathogenesis
World J Gastroenterol
Irritable bowel syndrome: pathogenesis, diagnosis, treatment, and evidence-based medicine
World J Gastroenterol
Endocrine cells in the ileum of patients with irritable bowel syndrome
World J Gastroenterol
Zespół nadwrażliwego jelita - nadwrażliwe jelito czy nadwrażliwy umysł?
Pol Merkur Lekarski
Irritable bowel syndrome: epidemiology, diagnosis and treatment: an update for health-care practitioners
J Gastroenterol Hepatol
Epidemiology of pediatric functional abdominal pain disorders: a meta-analysis
PLoS One
Functional gastrointestinal disorders: history, pathophysiology, clinical features and Rome IV
Gastroenterology
Functional disorders: children and adolescents
Gastroenterology
“Red flag” evaluation yield in irritable bowel syndrome
J Gastrointestin Liver Dis
Red flags of organic recurrent abdominal pain in children: study on 100 subjects
Iran J Pediatr
Irritable bowel syndrome in children: pathogenesis, diagnosis and evidence-based treatment
World J Gastroenterol
Irritable bowel syndrome: a disease still searching for pathogenesis, diagnosis and therapy
World J Gastroenterol
Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options
J Physiol Pharmacol
Prevalence of symptoms meeting criteria for irritable bowel syndrome in inflammatory bowel disease: systematic review and meta-analysis
Am J Gastroenterol
Is irritable bowel syndrome an organic disorder?
World J Gastroenterol
The diagnostic accuracy of fecal calprotectin during the investigation of suspected pediatric inflammatory bowel disease
Am J Gastroenterol
Negative results of antiendomysial antibodies: long term follow up
Arch Dis Child
The prevalence of overgrowth by aerobic bacteria in the small intestine by small bowel culture: relationship with irritable bowel syndrome
Dig Dis Sci
Abnormal breath testing in IBS: a meta-analysis
Dig Dis Sci
Irritable bowel syndrome
Nat Rev Dis Primers
Diagnosis of IBS: symptoms, symptom-based criteria, biomarkers or ‘psychomarkers’?
Nat Rev Gastroenterol Hepatol
Colonoscopy as an adjunctive method for the diagnosis of irritable bowel syndrome: focus on pain perception
J Gastroenterol Hepatol
The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress
Aliment Pharmacol Ther
The need for a new medical model: a challenge for biomedicine
Science
Stress and the microbiota-gut-brain axis in visceral pain: relevance to irritable bowel syndrome
CNS Neurosci Ther
Fundamentals of neurogastroenterology: physiology/motility – sensation
Gastroenterology
Extrinsic primary afferent signalling in the gut
Nat Rev Gastroenterol Hepatol
Is the irritable gut an inflamed gut?
Scand J Gastroenterol Suppl
The intestinal microenvironment and functional gastrointestinal disorders
Gastroenterology
Irritable bowel syndrome: a clinical review
World J Gastroenterol
Microbiota-host interactions in irritable bowel syndrome: epithelial barrier, immune regulation and brain-gut interactions
World J Gastroenterol
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