Irritable Bowel Syndrome: Diagnosis to Emerging Therapies
Irritable Bowel Syndrome: Diagnosis to Emerging Therapies
Purpose of review Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder characterized by abdominal discomfort or pain that is accompanied by a disturbance in defecation. Although the exact etiopathogenesis is not completely understood, recent advances in the understanding of the biochemical, physiologic, and biopsychosocial mechanisms of IBS have resulted in exciting new insights as well as therapies. This article will review the recent developments in pathogenesis, diagnosis, and treatment.
Recent findings IBS may be the product of various pathogenic mechanisms which include IBS as a serotonergic disorder; the role of genetics; IBS as an inflammatory state and the potential role of mast cells; IBS as a result of bacterial overgrowth and altered gastrointestinal microbiome; and abnormal pain processing and pain memory. Emerging therapies have developed targeting these mechanisms.
Summary IBS remains a symptom-based diagnosis that can usually be made comfortably based on clinical history without testing in the absence of alarm features. Novel and emerging therapies that are based upon the evolving understanding of the pathophysiology of IBS hold significant promise and for the first time there are potential therapies that may alter the natural history of this disorder.
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder (FGID) characterized by symptoms of recurrent abdominal pain or discomfort directly associated with disturbances in defecation which are not explained by structural abnormalities. IBS is very common in the North American population with the prevalence estimated to be between 10 and 15%. Although it has not been found to negatively impact survival, IBS continues to account for significant morbidity and heavy utilization of healthcare resources. IBS has been estimated to account for 3.5 million annual physician visits in the USA and is associated with annual direct costs of US$ 1.6 billion and indirect costs of US$ 19.2 billion. These figures are staggering considering that only a minority of those with IBS actually seek care for their symptoms.
Given its prevalence in the community and dramatic impact on both patients and healthcare utilization, there has been a clear impetus to better define the etiopathogenesis of IBS and to identify safe and effective therapies. However, to date, no definitive biomarkers or physiologic disturbances have been identified. As a result, available therapies that address the entire syndrome complex and alter the natural history of IBS have largely been lacking, with most traditional therapies focused on improving individual symptoms that comprise the syndrome.
Despite these limitations, this remains an exciting time as IBS represents an area of intense investigation from multiple directions. Therapy that alters the natural history of IBS has been identified for the first time, and current knowledge of IBS is constantly in evolution. As novel insights into its pathophysiology emerge it seems likely that better therapies will be identified. This article will provide a global review including recent developments in terms of pathogenesis, diagnosis, and emerging therapies for IBS.
Abstract and Introduction
Abstract
Purpose of review Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder characterized by abdominal discomfort or pain that is accompanied by a disturbance in defecation. Although the exact etiopathogenesis is not completely understood, recent advances in the understanding of the biochemical, physiologic, and biopsychosocial mechanisms of IBS have resulted in exciting new insights as well as therapies. This article will review the recent developments in pathogenesis, diagnosis, and treatment.
Recent findings IBS may be the product of various pathogenic mechanisms which include IBS as a serotonergic disorder; the role of genetics; IBS as an inflammatory state and the potential role of mast cells; IBS as a result of bacterial overgrowth and altered gastrointestinal microbiome; and abnormal pain processing and pain memory. Emerging therapies have developed targeting these mechanisms.
Summary IBS remains a symptom-based diagnosis that can usually be made comfortably based on clinical history without testing in the absence of alarm features. Novel and emerging therapies that are based upon the evolving understanding of the pathophysiology of IBS hold significant promise and for the first time there are potential therapies that may alter the natural history of this disorder.
Introduction
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder (FGID) characterized by symptoms of recurrent abdominal pain or discomfort directly associated with disturbances in defecation which are not explained by structural abnormalities. IBS is very common in the North American population with the prevalence estimated to be between 10 and 15%. Although it has not been found to negatively impact survival, IBS continues to account for significant morbidity and heavy utilization of healthcare resources. IBS has been estimated to account for 3.5 million annual physician visits in the USA and is associated with annual direct costs of US$ 1.6 billion and indirect costs of US$ 19.2 billion. These figures are staggering considering that only a minority of those with IBS actually seek care for their symptoms.
Given its prevalence in the community and dramatic impact on both patients and healthcare utilization, there has been a clear impetus to better define the etiopathogenesis of IBS and to identify safe and effective therapies. However, to date, no definitive biomarkers or physiologic disturbances have been identified. As a result, available therapies that address the entire syndrome complex and alter the natural history of IBS have largely been lacking, with most traditional therapies focused on improving individual symptoms that comprise the syndrome.
Despite these limitations, this remains an exciting time as IBS represents an area of intense investigation from multiple directions. Therapy that alters the natural history of IBS has been identified for the first time, and current knowledge of IBS is constantly in evolution. As novel insights into its pathophysiology emerge it seems likely that better therapies will be identified. This article will provide a global review including recent developments in terms of pathogenesis, diagnosis, and emerging therapies for IBS.
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