Irritable bowel syndrome: The evolution of multi-dimensional looking and multidisciplinary treatments

Abstract

Irritable bowel syndrome (IBS) is common in the society. Among the putative pathogeneses, gut dysmotility results in pain and disturbed defecation. The latter is probably caused by the effect of abnormal gut water secretion. The interaction between abnormal gas accumulation, abdominal pain and bloating remains controversial. Visceral hypersensitivity and its modification along with the central transmission are the characteristics of IBS patients. The identification of biologic markers based on genetic polymorphisms is undetermined. Imbalanced gut microbiota may alter epithelial permeability to activate nociceptive sensory pathways which in turn lead to IBS. Certain food constituents may exacerbate bowel symptoms. The impact of adult and childhood abuses on IBS is underestimated. Using the concept of biopsychosocial dysfunction can integrate multidimensional pathogeneses. Antispasmodics plus stool consistency modifiers to treat the major symptoms and defecation are the first-line drug treatment. New drugs targeting receptors governing bowel motility, sensation and secretion can be considered, but clinicians must be aware of their potential serious side effects. Psychiatric drugs and modalities may be the final options for treating intractable subjects. Probiotics of multi-species preparations are safe and worth to be considered for the treatment. Antibiotics are promising but their long-term safety and effectiveness are unknown. Diet therapy including exclusion of certain food constituents is an economic measure. Using relatively safe complementary and alternative medicines (CAMs) may be optional to those patients who failed classical treatment. In conclusion, IBS is a heterogeneous disorder with multidimensional pathogeneses. Personalized medicines with multidisciplinary approaches using different classes of drugs, psychiatric measures, probiotics and antibiotics, dietary therapy, and finally CAMs, can be considered.

Visceral and somatic hypersensitivity, autonomic cardiovascular dysfunction and low-grade inflammation in a subset of irritable bowel syndrome patients

“…The possible reason is that many patients with IBS also exhibit a wide variety of extra-intestinal symptoms. From our results, individualized treatments (such as cognitive behavioral therapy, hypnotherapy, dietotherapy, relaxation, and stress management in improving the function of the ANS, and traditional Chinese medicine and acupuncture to relieve somatic hypersensitivity) are recommended to alleviate the extra-intestinal symptoms (Rahimi and Abdollahi, 2012;Wilkins et al, 2012;Chang, 2014). According to our data, the remission of extra-intestinal symptoms may be associated with the alleviation of gastrointestinal symptoms in D-IBS patients.…”

Eluxadoline for the treatment of diarrhoea-predominant irritable bowel syndrome

“…[17] for the management of abdominal pain and constipation (namely IBS-C); antidiarrheal agents (e.g. loperamide, alosetron, and ramosetron) [18] and antibiotics (neomycin and rifaximin) for the management of abdominal pain and diarrhea (namely IBS-D) [19]; agents reducing bloating and flatulence (e.g. vegetable carbon and simethicone), and agents affecting overall symptoms (pre-and probiotics, psychotropic agents).…”

Traitement du syndrome du côlon irritable : l’impact de la microkinésithérapie

“…De telles perturbations peuvent affecter la régulation de la perception viscérale et la réponse émotionnelle aux événements viscéraux [12]. La nature multifactorielle du SCI signifie qu'une variété d'approches différentes est utilisée pour son traitement, comprenant différents recours pharmacologiques, des thérapies psychiatriques, probiotiques et des antibiotiques, la thérapie diététique et la médecine alternative complémentaire (MAC) [13,14].…”