Need for a comprehensive medical approach to the neuro-immuno-gastroenterology of irritable bowel syndrome

Abstract

Irritable bowel syndrome (IBS) is defined by the Rome III criteria as symptoms of recurrent abdominal pain or discomfort with the onset of a marked change in bowel habits with no evidence of an inflammatory, anatomic, metabolic, or neoplastic process. As such, many clinicians regard IBS as a central nervous system problem of altered pain perception. Here, we review the recent literature and discuss the evidence that supports an organic based model, which views IBS as a complex, heterogeneous, inter-dependent, and multi-variable inflammatory process along the neuronal-gut axis. We delineate the organic pathophysiology of IBS, demonstrate the role of inflammation in IBS, review the possible differences between adult and pediatric IBS, discuss the merits of a comprehensive treatment model as taught by the Institute of Functional Medicine, and describe the potential for future research for this syndrome.

Keywords: Abdominal pain; Inflammation; Irritable bowel syndrome; Probiotics; Stress.

Figure 1

Proposed pathophysiology of irritable bowel syndrome. CRF: Corticotropin-releasing factor; SIBO: Small intestinal bacterial overgrowth; PAR2: Proteinase-activated receptor-2.