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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2016; 22(7): 2242-2255
Published online Feb 21, 2016. doi: 10.3748/wjg.v22.i7.2242
Inflammation in irritable bowel syndrome: Myth or new treatment target?
Emanuele Sinagra, Giancarlo Pompei, Giovanni Tomasello, Francesco Cappello, Gaetano Cristian Morreale, Georgios Amvrosiadis, Francesca Rossi, Attilio Ignazio Lo Monte, Aroldo Gabriele Rizzo, Dario Raimondo
Emanuele Sinagra, Francesca Rossi, Dario Raimondo, Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy
Emanuele Sinagra, PhD Course in Surgical Biotechnology and Regenerative Medicine, University of Palermo, 90100 Palermo, Italy
Emanuele Sinagra, Giovanni Tomasello, Francesco Cappello, Euro-Mediterranean Institute of Science and Technology (IEMEST), 90100 Palermo, Italy
Giancarlo Pompei, Pathology Unit, Fondazione Istituto San Raffaele Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy
Giovanni Tomasello, Francesco Cappello, Department of Experimental Biomedicine and Clinical Neuroscience, Section of Human Anatomy, University of Palermo, 90100 Palermo, Italy
Gaetano Cristian Morreale, Georgios Amvrosiadis, Unit of Gastroenterology, Ospedali Riuniti Villa Sofia-Vincenzo Cervello, 90100 Palermo, Italy
Attilio Ignazio Lo Monte, DICHIRONS, Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, 90100 Palermo, Italy
Aroldo Gabriele Rizzo, Unit of Pathology, Ospedali Riuniti Villa Sofia-Vincenzo Cervello, 90100 Palermo, Italy
Author contributions: Sinagra E designed the study; Morreale GC and Amvrosiadis G wrote the paper; Rizzo AG and Pompei G provided pictures supporting the studies; Rossi F contributed to the revision of the manuscript; Tomasello G wrote the section describing the role of endoscopy in irritable bowel syndrome; and Lo Monte AI, Cappello F and Raimondo D supervised the work.
Conflict-of-interest statement: All the authors declare that this research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors, thus disclosing any conflict of interests regarding such work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Emanuele Sinagra, Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele Giglio, Contrada Pietra Pollastra Pisciotto, via Zagara Snc, Contrada Ogliastrillo, 90015 Cefalù, Italy. emanuelesinagra83@googlemail.com
Telephone: +39-3-270193383 Fax: +39-9-21920406
Received: June 1, 2015
Peer-review started: June 3, 2015
First decision: July 17, 2015
Revised: September 28, 2015
Accepted: December 19, 2015
Article in press: December 19, 2015
Published online: February 21, 2016
Processing time: 243 Days and 17.6 Hours
Abstract

Low-grade intestinal inflammation plays a key role in the pathophysiology of irritable bowel syndrome (IBS), and this role is likely to be multifactorial. The aim of this review was to summarize the evidence on the spectrum of mucosal inflammation in IBS, highlighting the relationship of this inflammation to the pathophysiology of IBS and its connection to clinical practice. We carried out a bibliographic search in Medline and the Cochrane Library for the period of January 1966 to December 2014, focusing on publications describing an interaction between inflammation and IBS. Several evidences demonstrate microscopic and molecular abnormalities in IBS patients. Understanding the mechanisms underlying low-grade inflammation in IBS may help to design clinical trials to test the efficacy and safety of drugs that target this pathophysiologic mechanism.

Keywords: Inflammation; Irritable bowel syndrome; Mast cells; Neuroendocrine cells; Pathology

Core tip: Low-grade intestinal inflammation plays a key role in the pathophysiology of irritable bowel syndrome, and this influence is likely multifactorial. Several evidences showed microscopic and molecular abnormalities in large subsets of patients with irritable bowel syndrome. Understanding the mechanisms underlying the low-grade inflammation in this disease may help to design clinical trials to test the efficacy and safety of drugs that target this pathophysiologic mechanism.