Irritable bowel syndrome - from etiopathogenesis to therapy

Abstract

Irritable bowel syndrome (IBS) is a chronic and relapsing functional gastrointestinal disorder that affects 9-23% of the population across the world. Patients with IBS are often referred to gastroenterology, undergo various investigations, take various medicines, take time off work and have a poor quality of life. The pathophysiology of IBS is not yet completely understood and seems to be multifactorial. Many pathogenetic factors, in various combinations, and not all necessarily present in each patient, can play an important role. Discomfort or abdominal pain relieived by defacation, asociated with a change in stool form, is a typical clinical manifestation of IBS. Many factors, such as emotional stress and eating, may exacerbate the symptoms. A timely diagnosis of IBS is important so that treatment which will provide adequate symptomatic relief (diarrhoea, constipation, pain and boaring) can be introduced. The diagnosis of IBS is not confirmed by a specific test or structural abnormality. It is made using criteria based on clinical symptoms such as Rome criteria, unless the symptoms are thought to be atypical. Today the Rome Criteria IV is the current gold-standard for the diagnoses of IBS. Treatment of patients with IBS requires a multidisciplinary approach. Some patients respond well to non-pharmacological treatment, while others also require pharmacological treatment. This review will provide a summary of pathophysiology, diagnostic criteria and therapies for IBS.

Pathophysiologic Approach to Pain Therapy for Complex Pain Entities: A Narrative Review

“…A significant correlation has been demonstrated between serotonin polymorphisms and chronic visceral pain severity. For example, in patients with irritable bowel syndrome, it was observed that plasma serotonin concentrations were reduced in patients with constipation but elevated in those with diarrhea [52]. Therefore, there has been considerable interest in these receptors as possible therapeutic targets [52].…”

“…For example, in patients with irritable bowel syndrome, it was observed that plasma serotonin concentrations were reduced in patients with constipation but elevated in those with diarrhea [52]. Therefore, there has been considerable interest in these receptors as possible therapeutic targets [52]. A possible role of genetic polymorphisms coding for anti-inflammatory and proinflammatory interleukins (IL), a-2 adrenergic receptors, and serotonin and cholecystokinin (CCK) receptors has also been suggested [52].…”

“…Therefore, there has been considerable interest in these receptors as possible therapeutic targets [52]. A possible role of genetic polymorphisms coding for anti-inflammatory and proinflammatory interleukins (IL), a-2 adrenergic receptors, and serotonin and cholecystokinin (CCK) receptors has also been suggested [52].…”

“…The clinician has several options in the armamentarium against chronic visceral pain, including laxatives, antidiarrheals, antispasmodics (mebeverine hydrochloride, hyoscine butylbromide, and peppermint oil), probiotics, fecal microbiota transplantation, and serotonin receptor agonists (tegaserod, prucalopride, renzapride) and antagonists (alosetron, ramosetron). In addition, anti-inflammatory therapies such as rifaximin, corticosteroids, mast cell stabilizers, and mesalazine may be used [52].…”

Silencing interleukin 1α underlies a novel inhibitory role of miR‐181c‐5p in alleviating low‐grade inflammation of rats with irritable bowel syndrome

“…Many patients suffering from IBS choose to be treated with traditional Chinese medicine or integrated therapies with decreased side effects instead of taking conventional medications . However, the treatment for IBS with elusive pathophysiology is far from multidisciplinary . Therefore, it is urgent to find molecular mechanism underlying IBS for more treatment options.…”