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.

Keywords: Antispasmodics, Biopsychosocial dysfunction, Comorbidity, Genetics, Irritable bowel syndrome, Microbiota, Probiotics, Visceral hyperalgesia

Core tip: Irritable bowel syndrome (IBS) is common in the society. Patients with this disorder have a poor quality of life with severe impact on their social and economic burdens. Its pathogenesis remains evolutional, involving biological, psychiatric and social factors. Therefore, the biopsychosocial dysfunctional model has attempted to integrate all the above mentioned mechanisms in order to understand how IBS can develop under such complex interaction. Since the etiology of IBS is heterogeneous, the currently recommended treatments are multidisciplinary and also individualized, e.g., using different classes of drugs, psychiatric measures, probiotics and antibiotics, dietary therapy, and finally complementary and alternative medicines.