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Original research
Irritable bowel syndrome: treatment based on pathophysiology and biomarkers
  1. Michael Camilleri1,
  2. Guy Boeckxstaens2
  1. 1Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Center of Intestinal Neuroimmune Interaction, Division of Gastroenterology, Translational Research Center for GI Disorders (TARGID), Leuven University, Leuven, Belgium
  1. Correspondence to Dr Michael Camilleri, Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA; camilleri.michael{at}mayo.edu

Abstract

Objective To appraise the evidence that pathophysiological mechanisms and individualised treatment directed at those mechanisms provide an alternative approach to the treatment of patients with irritable bowel syndrome (IBS).

Design A PubMED-based literature review of mechanisms and treatment of IBS was conducted independently by the two authors, and any differences of perspective or interpretation of the literature were resolved following discussion.

Results The availability of several noninvasive clinical tests can appraise the mechanisms responsible for symptom generation in IBS, including rectal evacuation disorders, abnormal transit, visceral hypersensitivity or hypervigilance, bile acid diarrhoea, sugar intolerances, barrier dysfunction, the microbiome, immune activation and chemicals released by the latter mechanism. The basic molecular mechanisms contributing to these pathophysiologies are increasingly recognised, offering opportunities to intervene with medications directed specifically to food components, receptors and potentially the microbiome. Although the evidence supporting interventions for each mechanism is not at the same level of proof, the current state-of-the-art provides the opportunity to advance the practice from treatment based on symptoms to individualisation of treatment guided by pathophysiology and clinically identified biomarkers.

Conclusion These advances augur well for the implementation of evidence-based individualised treatment for patients with IBS based on actionable biomarkers or psychological disturbances.

  • irritable bowel syndrome

Data availability statement

All data relevant to the study are included in the article.

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Data availability statement

All data relevant to the study are included in the article.

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Footnotes

  • Contributors MC: guarantor of the article; initial conceptualisation, first and subsequent drafts; GB: conceptual feedback, scientific verification, editing of all drafts of manuscript.

  • Funding MC: grant R01-DK115950 from National Institutes of Health; GB: Leuven University internal funding grant C1 (C14/18/086).

  • Competing interests MC: consulting regarding irritable bowel syndrome for Ironwood; Protagonist Therapeutics; Zealand Biopharma; Aditum Bio; Invea Therapeutics and InveniAI.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.