Irritable bowel syndrome: recent developments in diagnosis, pathophysiology, and treatment

Abstract

The diagnosis of irritable bowel syndrome (IBS) remains a diagnosis of exclusion, whereby an extensive investigation is performed to exclude other organic diseases that may explain the symptoms of patients. Attempts to have a positive diagnosis based on symptom assessments failed to achieve widely use in clinical practice. Abnormalities in the gastrointestinal endocrine cells in IBS patients have been reported recently, providing evidence that IBS is an organic disorder, and opening the door to the use of these abnormalities as markers for a positive diagnosis of IBS. New and promising drugs for the treatment of IBS with constipation as the predominant symptom are currently on the market, and the treatment results have been satisfactory thus far.

Keywords::

• biomarkers
• chromogranin A
• diagnosis
• dysmotility
• endocrine cells
• pathophysiology
• PYY
• Rome criteria
• somatostatin
• visceral hypersensitivity

Authors contribution

M El-Salhy collected data from the literature and wrote the manuscript; OH Gilja, JG Hatlebakk, D Gundersen and T Hausken contributed equally to discussions about the collected data and commented upon the manuscript. All of the authors approved the submitted version of the manuscript.

Financial & competing interests disclosure

The studies conducted by the authors and cited in this review were supported by a grant from Helse-Fonna. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• In clinical practice, the diagnosis of irritable bowel syndrome (IBS) remains a diagnosis of exclusion.

• IBS patients have structural lesions in their gastrointestinal endocrine cells.

• The structural lesions can explain gastrointestinal dysmotility and visceral hypersensitivity and can be used for a positive diagnosis of IBS.

• Drugs acting on gut hormone receptors can be beneficial for the treatment of IBS.

• Large intestinal low-grade inflammation plays an important role in the pathophysiology of post-infectious IBS.

• Hereditary factors may play an important role in the development of the abnormalities in the gastrointestinal endocrine cells in IBS.