Journal ArticleDOI
Irritable Bowel Syndrome: A Clinical Review
TLDR
Central Sensitization (CS) would offer a way to conceptualize an integration of life experience and psychologic response into a biopsychosocial framework of pathophysiology, diagnosis and treatment of IBS.Abstract:
Symptoms of irritable bowel syndrome (IBS) are common in population studies including chronic abdominal pain associated with altered bowel habits. Patients often have associated gastrointestinal and somatic symptoms suggesting a possible common contributing mechanism, but the heterogeneous symptom patterns of individual patients make generalizations difficult. The pathophysiology of IBS is incompletely understood but includes disturbances of the brain-gut axis. Central mechanisms are: the psychosocial history and environment, dysfunctional brain processing of peripheral signals attributed to the intestine including the enteric nervous system, the microbiome and the innate and adaptive immune system. As a result there is visceral hypersensitivity and disturbed intestinal secretory and motor activity. Some mechanisms of visceral pain hypersensitivity may overlap with other pain syndromes including fibromyalgia (FMS). Central Sensitization (CS) would offer a way to conceptualize an integration of life experience and psychologic response into a biopsychosocial framework of pathophysiology, diagnosis and treatment of IBS. Corticotropin-releasing factor, a principle regulator in the stress and pain response may contribute to a neuroendocrine mechanism for the brain-gut interaction. The positive diagnostic approach to IBS symptoms to avoid excess testing and enhance the patient-provider therapeutic relationship requires the recognition of the "cluster" of IBS symptoms while identifying "alarm" symptoms requiring specific attention. The severity of the symptoms and other individual psychosocial factors characterize patients who seek medical care. The presence of significant psychosocial comorbidities adds to the complexity of management which often requires a multidisciplinary approach. Several treatment options exist but no single method is effective for all the symptoms of IBS. The therapeutic benefit of the well-executed physician-patient relationship is considered essential to success in managing IBS symptoms over the long term.read more
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Journal ArticleDOI
Breaking down the barriers: the gut microbiome, intestinal permeability and stress-related psychiatric disorders
TL;DR: This review will discuss the possible role played by the gut microbiota in maintaining intestinal barrier function and the CNS consequences when it becomes disrupted, and draw on both clinical and preclinical evidence to support this concept.
Journal ArticleDOI
Impact of the Gut Microbiota on Intestinal Immunity Mediated by Tryptophan Metabolism
TL;DR: This review clarifies how the gut microbiota regulates Trp metabolism and identifies the underlying molecular mechanisms of these interactions.
Journal ArticleDOI
A Randomized Controlled Trial Comparing the Low FODMAP Diet vs. Modified NICE Guidelines in US Adults with IBS-D
TL;DR: In this US trial, 40–50% of patients reported adequate relief of their IBS-D symptoms with the low FODMAP diet or a diet based on modified NICE guidelines, which led to significantly greater improvement in individual IBS symptoms, particularly pain and bloating, compared with the mNICE diet.
Journal ArticleDOI
Faecal microbiota transplantation alters gut microbiota in patients with irritable bowel syndrome: results from a randomised, double-blind placebo-controlled study
Sofie Ingdam Halkjær,Alice Højer Christensen,Bobby Lo,Patrick Denis Browne,Stig Günther,Lars Hestbjerg Hansen,Andreas Petersen +6 more
TL;DR: It is found that FMT changed gut microbiota in patients with IBS, but patients in the placebo group experienced greater symptom relief compared with the FMT group after 3 months, suggesting that altering the gut microbiota is not enough to obtain clinical improvement in IBS.
Journal ArticleDOI
Effects of varying dietary content of fermentable short-chain carbohydrates on symptoms, fecal microenvironment, and cytokine profiles in patients with irritable bowel syndrome.
T. N. Hustoft,Trygve Hausken,Trygve Hausken,S.O. Ystad,S.O. Ystad,Jørgen Valeur,Karl A. Brokstad,Jan Gunnar Hatlebakk,Jan Gunnar Hatlebakk,Gülen Arslan Lied,Gülen Arslan Lied +10 more
TL;DR: The effects of a blinded low‐FODMAP vs high‐fructo‐oligosaccharides (FOS) diet on symptoms, immune activation, gut microbiota composition, and short‐chain fatty acids (SCFAs) are investigated.