In recent decades, we have regarded irritable bowel syndrome (IBS) as a functional disorder which means symptoms of IBS are not explained by identifiable structural or biochemical abnormalities. 1 Under the premise that the symptom of IBS originated from disturbance of function, multi-factorial etiologies have been suggested, including abnormal motility, visceral hypersensitivity, genetic predisposition, and psycho-social influences. Of these, the role of the central nervous system in terms of brain-gut interaction has been considered as an important factor for abnormal motility and visceral hypersensitivity, and has been intensively studied. For example, the corticotrophin-releasing factor, a key modulator of stress response in the brain, has been extensively investigated and the present role in the gastrointestinal tract such as decreasing gastric emptying, increasing colonic motility, and inducing visceral hypersensitivity are established. [2][3][4] Psychological comorbidities such as depression and anxiety are also more prevalent in patients with IBS compared to healthy controls and is thought to play an important role in IBS.1 However, latest medical and scientific developments have led to further investigation of organic changes in patients with IBS such as inflammatory cell infiltration, increased permeability, and changes in neuroendocrine system in the gut. 5,6 The enteric nervous system (ENS) is one of the candidates for a possible organic cause of underlying IBS pathophysiology. The ENS regulates muscular, neuro-hormonal, and secretory systems of the gastrointestinal tract to generate functionally effective patterns of various digestive states.
7The ENS can be divided into 2 major regions, the submucosal plexus (SMP) and the myenteric plexus (MP). The SMP controls absorptive and secretory functions of the mucosal epithelium, intramural blood flow, and neuroimmune interactions, while the MP regulates intestinal motility for specific digestive states.