The lancet. Gastroenterology & hepatology

How Irritable Bowel Syndrome Develops and Affects the Body

Updated

Abstract

A wide range of underlying pathophysiological abnormalities are associated with irritable bowel syndrome (IBS).

  • Peripheral mechanisms linked to IBS include gastrointestinal infection, changes in the gut microbiome, and visceral hypersensitivity.
  • Increased intestinal permeability and low-grade mucosal inflammation may contribute to IBS symptoms.
  • Central mechanisms such as psychological health and altered pain processing are also involved in IBS.
  • The integration of central and peripheral mechanisms supports the concept of IBS as a gut-brain interaction disorder.
  • Some mechanisms, like abnormal bile acid metabolism and accelerated colonic transit, can be quantified using validated tests.

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Full Text

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Funding

Competing interests

Declaration of interests YN has received travel reimbursement from the American Neurogastroenterology and Motility Society, the International Union of Physiological Sciences, and the Canadian Association of Gastroenterology; and grant funding from the Canadian Institutes for Health Research Project, the Weston Family Microbiome Mechanisms grant, TRIANGLE Canada patient engagement seed funding, Crohn's and Colitis Canada, and the Rome Foundation. AS serves as a consultant for Ardelyx, served on an advisory board for Gemelli Biotech and Salix Pharmaceuticals and as a consultant for ModernGut, and is an advisor for Medis Labs. She has received speaker honoraria from the Southern California Society of Gastroenterology, the Rome Foundation, the American College of Gastroenterology, and the American Neurogastroenterology and Motility Society; travel reimbursement from Ardelyx, the American College of Gastroenterology, the Rome Foundation, the American Neurogastroenterology and Motility Society, and Focus Medical Communications; and Established Investigator Bridge Funding from the American College of Gastroenterology with payment made to her institution. ACF has received grant funding from the National Institute for Health and Care Research with payment made to his institution. MC has acted as a consultant for McDermott Will and Emery, Alfasigma, Biokier, Coloplast, and Eli Lilly with the fees paid to Mayo Clinic; received consultancy fees from Monteresearch, Dignify Therapeutics, Intercept Pharmaceuticals, Mirum Pharmaceuticals, Aclipse Therapeutics, CinDome and Medpace, Monteresearch, Cumberland Pharma, Alimentiv, and Dr Falk Pharma, and Motive Medical Intelligence; has stock options with Dignify Therapeutics and Phenomix; and holds patents relating to (13)C-mannitol for permeability measurement (not commercialised; if brought to market money would be received by the Mayo Clinic with a proportion shared with inventors, including MC), capsule for colonic transit by scintigraphy (not commercialised; if brought to market money would be received by the Mayo Clinic with a proportion shared with inventors, including MC), and obesity metabolomics to identify different phenotypes, with Phenomix having made a deal with Mayo Clinic for the rights to the product, which is currently on the market with money paid to Phenomix; and has received grant income for single-centre research trials from Biocodex, Pfizer, Vanda, and ExeGi. CJB has received consultancy fees from FW Medical; grant funding from the National Institute for Health and Care Research with payment made to his institution; speaker honoraria from Takeda and Dr Falk; and travel reimbursement from Viatris and Dr Falk.
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