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Irritable bowel syndrome (IBS) is a common and well-accepted diagnosis but often imprecisely applied to patients in usual clinical practice. Diagnosis is entirely based on symptom criteria that tend to include broad strata of abdominal complainers. Established criteria for diagnosis are strictly followed in controlled clinical trials for new therapeutic agents, but physicians are more lax in the clinic. Predictably, in light of the above ambiguities, many pathogenetic mechanisms and pathophysiological disturbances appear to be involved in IBS, but so far no mechanism-based subgroupings to guide specific therapy have been soundly established. Thus, diverse therapeutic approaches coexist and are discretionally prescribed by attending clinicians on the basis of major manifestations (i.e., diarrhea-predominance or constipation-predominance), more or less apparent psychological disturbances, and patient preferences (pharmacological versus dietary or microbiological approaches). In this review, we have attempted to update scientific knowledge about the more relevant disease mechanisms involved and relate this more fundamental basis to the various treatment options available today.
Sperber AD, Dumitrascu D, Fukudo S, et al. The global prevalence of IBS in adults remains elusive due to the heterogeneity of studies: a Rome Foundation working team literature review. Gut 2016. doi: 10.1136/gutjnl-2015-311240.
Card TR, Siffledeen J, Fleming KM. Are IBD patients more likely to have a prior diagnosis of irritable bowel syndrome? Report of a case-control study in the General Practice Research Database. United Eur Gastroenterol J. 2014;2(6):505–12. CrossRef
Quigley EM, Shanahan F. The language of medicine: words as servants and scoundrels. Clin Med (Lond). 2009;9(2):131–5. CrossRef
Wouters MM, Van Wanrooy S, Nguyen A, et al. Psychological comorbidity increases the risk for postinfectious IBS partly by enhanced susceptibility to develop infectious gastroenteritis. Gut 2015. doi: 10.1136/gutjnl-2015-309460.
Di Stefano M, Corazza GR. The rationale for antibiotics in IBS. Am J Gastroenterol. 2008;103(10):2652.
Miquel S, Martin R, Lashermes A, et al. Anti-nociceptive effect of Faecalibacterium prausnitzii in non-inflammatory IBS-like models. Sci Rep. 2016;6. doi: 10.1038/srep19399.
Wegner A, Banaszkiewicz A, Kierkus J, et al. Effectiveness of Lactobacillus reuteri in the treatment of functional constipation in children: a randomized, double-blind, placebo-controlled, multicenter trial. United Eur Gastroenterol J. 2015;3(5S):A20.
Rumessen JJ, Gudmand-Høyer E. Absorption capacity of fructose in healthy adults. Comparison with sucrose and its constituent monosaccharides. Gut 1986;27:1161–8.
De GR, Volta U, Gibson PR. Sensitivity to wheat, gluten and FODMAPs in IBS: facts or fiction? Gut. 2016;65(1):169–78. CrossRef
Eskesen D, Jespersen L, Michelsen B, Whorwell PJ, Muller-Lissner S, Morberg CM. Effect of the probiotic strain Bifidobacterium animalis subsp. lactis, BB-12(R), on defecation frequency in healthy subjects with low defecation frequency and abdominal discomfort: a randomised, double-blind, placebo-controlled, parallel-group trial. Br J Nutr. 2015;114(10):1638–46. CrossRefPubMedPubMedCentral
Catanzaro R, Anzalone M, Calabrese F, et al. The gut microbiota and its correlations with the central nervous system disorders. Panminerva Med. 2015;57(3):127–43. PubMed
Ghia JE, Park AJ, Blennerhassett P, Khan WI, Collins SM. Adoptive transfer of macrophage from mice with depression-like behavior enhances susceptibility to colitis. Inflamm Bowel Dis. 2011;17:1479–89. CrossRef
Pinto-Sanchez MI, Hall GB, Ghajar K, et al. Bifidobacterium longum NCC3001 improves depression and reduces brain emotional reactivity in patients with irritable bowel syndrome (IBS): a randomized, double blind, placebo-controlled trial. United Eur Gastroenterol J. 2015;3(5S):A53.
- Mechanism-Oriented Therapy of Irritable Bowel Syndrome
Juan R. Malagelada
- Springer Healthcare
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