Second Asian Consensus on Irritable Bowel Syndrome

Abstract

Background/Aims There has been major progress in our understanding of the irritable bowel syndrome (IBS), and novel treatment classes have emerged. The Rome IV guidelines were published in 2016 and together with the growing body of Asian data on IBS, we felt it is timely to update the Asian IBS Consensus. Methods Key opinion leaders from Asian countries were organized into 4 teams to review 4 themes: symptoms and epidemiology, pathophysiology, diagnosis and investigations, and lifestyle modifications and treatments. The consensus development process was carried out by using a modified Delphi method. Results Thirty-seven statements were developed. Asian data substantiate the current global viewpoint that IBS is a disorder of gut-brain interaction. Socio-cultural and environmental factors in Asia appear to influence the greater overlap between IBS and upper gastrointestinal symptoms. New classes of treatments comprising low fermentable oligo-, di-, monosacharides, and polyols diet, probiotics, non-absorbable antibiotics, and secretagogues have good evidence base for their efficacy. Conclusions Our consensus is that all patients with functional gastrointestinal disorders should be evaluated comprehensively with a view to holistic management. Physicians should be encouraged to take a positive attitude to the treatment outcomes for IBS patients.

Characteristics of fecal metabolic profiles in patients with irritable bowel syndrome with predominant diarrhea investigated using 1H‐NMR coupled with multivariate statistical analysis

“…Accordingly, increased levels of fecal amino acids could be considered as important disease‐relevant features of IBS‐D, and threonine, tryptophan, and phenylalanine might be potential therapeutic targets for IBS‐D. Serotonin modulating therapies have been already used to control IBS symptoms . Further studies are needed to evaluate the exact relationships between threonine and phenylalanine and IBS‐D and develop novel therapeutic agents modulating these amino acids.…”

Marshall and Warren Lecture 2019: A paradigm shift in pathophysiological basis of irritable bowel syndrome and its implication on treatment

“…Irritable bowel syndrome is multifactorial in pathogenesis 1–3, 15, 16 . These factors may be broadly classified into (i) peripheral factors 17 (viz., altered gastrointestinal [GI] motility, GI inflammation and permeability alteration, altered luminal microenvironment including gut microbiota dysbiosis and small intestinal bacterial overgrowth [SIBO], host–microbe interaction, bile acid recirculation defect, pathogenic infection, dietary factors, and neurohumoral dysregulation including altered serotonergic transmission and visceral hypersensitivity) and (ii) central factors (psychological stress, cognitive dysfunction, abnormal emotional arousal system response, and sleep dysfunction).…”

“…Whereas patients with constipation‐predominant IBS (IBS‐C) have slow gut, particularly colonic, transit, diarrhea‐predominant IBS (IBS‐D) patients have faster motility 1, 5, 19 . Multiple studies showed that Bristol stool form is determined by colonic motility; slower colon transit is associated with harder stools 20, 21 .…”

“…Irritable bowel syndrome (IBS), a common enigmatic functional gastrointestinal disorder (FGID), is characterized by abdominal pain, discomfort, bloating, altered stool forms, and frequency 1 . IBS is diagnosed by symptom‐based criteria such as Manning's criteria and different iteration of the Rome criteria 2, 3 .…”

The Effect of Phloroglucinol in Patients With Diarrhea-predominant Irritable Bowel Syndrome: A Randomized, Double-blind, Placebo-controlled Trial

“…1 IBS is a chronic disorder that may lead to impaired personal and social interactions of affected individuals. 2,3 However, the pathophysiology of IBS is still unclear. Various factors including visceral hypersensitivity, abnormal gut motility, immune activation, disorder of the brain-gut axis, impaired intestinal barrier function, and alteration of gut microbiota, have been suggested as main causes of IBS in previous literatures.…”