Irritable Bowel Syndrome

Ford, Alexander C.; Sperber, Ami D.; Corsetti, Maura; Camilleri, Michael

Abstract

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder whose symptoms include abdominal pain associated with a change in stool form or frequency. The condition affects between 5% and 10% of otherwise healthy individuals in the community at any one point in time and, in most people, runs a relapsing and remitting course. The best described risk factor is acute enteric infection, but IBS is also more common in people with psychological co-morbidity, and in young adult females. The pathophysiology of IBS remains incompletely understood, but it is well established that there is disordered communication between the gut and the brain, leading to motility disturbances, visceral hypersensitivity, and altered central nervous system processing. Other less reproducible mechanisms may include genetic associations, alterations in gastrointestinal microbiota, and disturbances in mucosal and immune function. In most people the diagnosis can be made based on the clinical history, with limited, judicious, use of investigations, unless alarm symptoms such as weight loss or rectal bleeding are present, or there is a family history of inflammatory bowel disease or coeliac disease. Once the diagnosis is made, an empathetic approach is key, and can improve quality of life and symptoms, and reduce health care expenditure. The mainstays of treatment include patient education about the condition, dietary changes, soluble fibre, and antispasmodic drugs. Other treatments tend to be reserved for those with more severe symptoms; these include central neuromodulators, intestinal secretagogues, drugs acting on 5-hydroxytryptamine or opioid receptors, or minimally absorbed antibiotics (all of which are selected according to predominant bowel habit), and psychological therapies. The increased understanding of the pathophysiology of IBS in the last 10 years has led to a healthy pipeline of novel drugs in development.

• Journal Article Type: Review
• Acceptance Date: Jul 3, 2020
• Online Publication Date: Oct 10, 2020
• Publication Date: Nov 21, 2020
• Deposit Date: Jul 3, 2020
• Publicly Available Date: Apr 11, 2021
• Journal: Lancet
• Print ISSN: 0140-6736
• Electronic ISSN: 1474-547X
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 396
• Issue: 10263
• Pages: 1675-1688
• DOI: https://doi.org/10.1016/S0140-6736%2820%2931548-8
• Public URL: https://nottingham-repository.worktribe.com/output/4746852
• Publisher URL: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31548-8/fulltext