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Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that is characterized by abdominal pain and altered bowel habits, often including bloating. The condition is common and can substantially affect quality of life and cause considerable economic burden. Intense research efforts into understanding the mechanisms that underlie IBS (including the role of the gut microbiota, gut–brain axis, genetics and immune system) are ongoing and new approaches for effective treatment are being developed, including dietary management and novel drugs.
Placebo analgesia is increasingly appreciated in many difficult to treat chronic functional gastrointestinal disorders such as IBS. However, investigations of interactions between psychological and biological placebo factors are still in early stages. Now, technologies have been developed that enable neural mechanisms of placebo analgesia to be studied more directly in humans.
IBS affects up to 15% of the population and continues to provide the medical profession with diagnostic and therapeutic challenges. The pathophysiology is complex and until it is better understood management strategies will necessarily remain rather empirical.
In the past decade we have witnessed an explosion in the quantity and quality of research in the functional gastrointestinal disorders. I discuss 10 top original research papers that, unless recent, have been highly cited, published in a high-impact journal and have probably shifted thinking in the field.
Evidence is mounting that molecular mechanisms underlie gut dysfunction and symptom generation in IBS. Although it is still an uphill struggle, this mounting evidence is a good starting point for the discovery of one or more IBS biomarkers.
Irritable bowel syndrome (IBS) is a functional gastrointestinal disease with a high prevalence. Enck et al. describe the association between IBS and other gastrointestinal, somatic and psychiatric conditions, as well as the current view on the pathophysiology, and diagnostic and management options.
The pathophysiology of IBS is multifactorial with a substantial genetic component. Although a variety of genetic and epigenetic changes have been associated with different IBS subtypes, reproducible validation of these results is still outstanding and pharmacogenetic strategies have yet to be devised. Here, the COST Action BM1106 GENIEUR (epi)genetic working group gives insights into the situation to date, advances and challenges that still need addressing.
IBS is the most common brain–gut disorder and a major cause of chronic abdominal pain. Here, Mayer and colleagues describe the key components of the gut–brain–microbiota axis in IBS and present a systems-based view of how these components interact to integrate the central, peripheral and behavioural IBS-related alterations.
Striking placebo responses seen in randomized clinical trials have generated an interest in investigating this phenomenon in gastroenterology. Sigrid Elsenbruch and Paul Enck discuss general aspects of the placebo response relating to gastroenterology and aspects that are unique to gastrointestinal disease. This Review provides a fascinating insight into placebo research and how this phenomenon could be exploited in the future for better patient care.
Chronic abdominal pain is common in children, but poorly understood. This Review summarizes the mechanisms and management of childhood functional abdominal pain in a bid to improve understanding and quality of care. The article provides up-to-date information on the epidemiology, pathophysiology, diagnosis and therapeutic management of this common childhood condition.
The pathophysiology of IBS is complex with a number of different factors involved. Here, the authors highlight crosstalk between the gut microbiota, enteroendocrine system, immune system (including neuroimmune interactions) and intestinal permeability in the development of IBS. Insights into how these entities might interact are discussed.
IBS is a prevalent condition worldwide that incurs substantial health-care costs. The condition can be difficult to diagnose owing to is multifactorial aetiology. Here, the authors provide an overview of the current approaches available to diagnose IBS, including symptoms, symptom-based criteria, biomarkers and psychological markers. Future directions for the field are also discussed.
The gut microbiota is now acknowledged to have a profound effect on human health and disease. Here, Stephen Collins explores the role of the gut microbiota in the development of IBS, describing experimental evidence and clinical observational and trial data that implicates the gut microbiota in the manifestation of IBS.
IBS is a debilitating chronic condition that substantially affects quality of life. Dietary management of IBS has garnered much interest, with dietary restriction of fermentable carbohydrates (the so-called low FODMAP diet) being explored as an approach to manage gastrointestinal symptoms in IBS. Here, the authors introduce the concept of fermentable carbohydrate restriction, providing an overview of the underlying mechanisms, efficacy and clinical application of this approach.