A Correlation Between the Pathogenic Processes of Fibromyalgia and Irritable Bowel Syndrome in the Middle-Aged Population: A Systematic Review

Abstract

Irritable bowel syndrome (IBS) is a common pathology in middle-aged patients and a regular consultation in the gastroenterology office. The prevalence is high in females with a ratio of 2:1, and due to its multifactorial etiology, it is difficult to address the symptomatology. On the other hand, fibromyalgia syndrome (FMS) is a chronic widespread pain syndrome also prevalent in the female population, characterized by systemic symptoms. It is proven that 28-59 % of patients with FMS develop IBS at some point in their illness; on the other hand, 32-77% of those with IBS will develop FMS. Our study aims to compile information about the pathogenesis of these diseases and highlight their common processes to target these two illnesses potentially.This systematic review comprises twenty-three studies published between 2017 and 2022, selected by electronic research with keywords and Medical Subject Headings (MESH) strategy. The articles were taken from PubMed, Pubmed Central (PMC), Medline, and Cochrane libraries and met the inclusion and exclusion criteria and the pertinent quality checklists. Of the reviewed studies, 10 were case-control, six were narrative reviews, three were systematic reviews, three were cross-sectional, and one was a cohort study. They investigated the correlation and similitudes in the pathogenic process between FMS and IBS.There are some similar mechanisms in the physiopathologies of IBS and FMS, where the immune system, especially the mast cells (MCs), along with their products, receptors, the inflammatory cells with their intermediaries, hormones, and neurotransmitters such as serotonin, act together pathologically. Also, the role of the microbiota is very important in this pathogenesis since dysbiosis alters the levels of serotonin in the body and can produce hyperstimulation of the autonomic nervous system.There are common associated factors in IBS and FMS, with evident symptoms presented in both syndromes such as fatigue, pain, hypersensitivity, depression, anxiety, and others, that could be correlated in a certain way. After this systematic review, we can conclude that the most accepted theories of the common pathogenesis are the role of serotonin and MCs with their inflammatory biomarkers, which can affect different parts of the body producing the characteristic symptomatology. Moreover, other pathogenic mechanisms such as the involvement of microbiota and dysregulation of the gut-brain axis have shown promising results, and further investigation should be made to support their role.

Implication of intestinal microbiota in the etiopathogenesis of fibromyalgia: A systematic review

“…The data that support the findings of this study are openly available in PUBMED at http://doi.org/10.55563/CLINEXPRHEUMATOL/257E99, reference number [22]. The data that support the findings of this study are openly available in PUBMED at http://doi.org/10.7759/CUREUS.29923, reference number [23]. The data that support the findings of this study are openly available in PUBMED at http://doi.org/10.3390/IJERPH19063254, reference number [24].…”

“…According to Rea et al., 16 this two‐way communication takes place in four ways: Circulatory and lymphatic systems: the biomolecules secreted by microbiota act through these two pathways, taking advantage of physiological transport functions to reach the brain after passing through the blood–brain barrier 16 Immune system: as a result of interaction between antigens, bacterial metabolites, and immune cells 16,21,22 (such as macrophages, mast cells, dendritic cells, or lymphocytes), an immune response is generated, stimulating pain signals at the gastrointestinal level 16,23 . In this case, the intestinal epithelial barrier loses its integrity, an alteration known as “leaky gut” or “intestinal transcytosis” that acts as an etiopathogenic factor in FM 17,18 …”

“…Immune system: as a result of interaction between antigens, bacterial metabolites, and immune cells 16,21,22 (such as macrophages, mast cells, dendritic cells, or lymphocytes), an immune response is generated, stimulating pain signals at the gastrointestinal level. 16,23 In this case, the intestinal epithelial barrier loses its integrity, an alteration known as "leaky gut" or "intestinal transcytosis" that acts as an etiopathogenic factor in FM. 17,18 3.…”

Aquatic Exercise in Physical Therapy Treatment for Fibromyalgia: Systematic Review

“…It is a syndrome that affects between 0.2% and 6.6% of the global population, particularly women over the age of 50 [ 2 , 3 ]. The pathophysiology of this disorder is not clearly defined [ 2 , 4 ], which complicates diagnosis and treatment, although its origin could be related to a combination of genetic, biological, psychological, and environmental factors [ 5 , 6 , 7 , 8 ].…”

Do the instruments used to assess fibromyalgia symptoms according to American College of Rheumatology criteria generate similar scores in other chronic musculoskeletal pain?

“…Fibromyalgia (or fibromyalgia syndrome) is a chronic condition characterized by widespread pain and complex symptomatology [ 1 ], such as fatigue [ 2 ], sleep disturbances [ 3 ], mood disorders [ 4 ], and symptoms not explained by structural changes [ 5 ]. Its prevalence varies from 2 to 6% in the world population and is more identified in women aged between 20 and 55 years [ 2 ].…”