How to meet the challenges of managing patients with IBS

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doi:doi: 10.12788/jfp.0299

Applied Evidence

How to meet the challenges of managing patients with IBS

J Fam Pract. 2021 November;70(9):431-441 | doi: 10.12788/jfp.0299

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References

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IBS patients also have comorbidities:

More than 20% of IBS patients have functional dyspepsia, gastroesophageal reflux disease, incontinence, or pelvic floor dyssynergia.⁴
The frequency of fibromyalgia syndrome in IBS patients is reported to be 20% to 65%.⁸
14% of IBS patients meet criteria for chronic fatigue syndrome.⁸
Interstitial cystitis and dyspareunia are common among IBS patients.⁹

Pathophysiology is complex

Models describing the pathophysiology of IBS have evolved through the years. Recent models describe it as a combination of altered gastrointestinal motility, visceral hyperalgesia, increased intestinal permeability, immune activation, altered intestinal microbiota, and dysfunction in the brain–gut axis. Certain environmental and psychological variables (eg, previous gastroenteritis, food intolerance, chronic stress, diverticulitis, and surgery) increase the risk of IBS.^1,10,11

In the past several years, considerable attention has been paid to the roles played by the immune system, brain–gut axis function, and intestinal microbiota in IBS manifestations. Research focus in these areas might assist in the development of specific treatment modalities targeting IBS subtypes.

Immune system. A recent meta-analysis of the records of 706 IBS patients found an increased number of mast cells and CD3 T cells in biopsy specimens from the rectosigmoid and descending colon of IBS patients.¹² Another study found a significant increase in mast cells in the ileum of IBS patients¹³; this increase is evident not only on intestinal biopsy but also at the serologic level. IBS-D patients have a higher plasma interleukin (IL)-6 level than the general population.¹⁴ Another meta-analysis found an imbalance in the serum level of tumor necrosis factor-α and IL-10 in IBS patients.¹⁵

Brain–gut axis. A 2016 meta-analysis showed that patients with anxiety and depression have a 2-fold increased risk of IBS.¹⁶A more recent study, using data from the National Health Insurance Research Database that included 22,356 patients with IBS, found a 3.6-fold increased risk of psychiatric disorders in IBS.¹⁷ These findings reflect the complex interaction between the brain and the intestinal tract in IBS.

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