Diagnosis of Irritable Bowel Syndrome: Role of Potential Biomarkers

Abstract

Irritable bowel syndrome is a disorder diagnosed on symptom-based criteria without inclusion of any objective parameter measurable by known diagnostic methods. Heterogeneity of the disorder and overlapping with more serious organic diseases increase uncertainty for the physician's work and increase the cost of confirming the diagnosis. This paper is an attempt to summarize the efforts to find adequate biomarkers for irritable bowel syndrome, which should shorten the time to diagnosis and reduce the cost. Most of the reviewed papers were observational studies from secondary care institutions. Since publication of the Rome III criteria in 2006, most recent studies use these for the recruitment of IBS patients. This is a positive step forward as future studies should use the same criteria, facilitating comparison of their results. Among the studied biomarkers, most evidence is provided for fecal calprotectin. Cutoff values for fecal calprotectin have still to be investigated prior to inclusion in the irritable bowel syndrome diagnostic algorithm.

Effects of Cognitive Behavior Therapy on Heart Rate Variability in Young Females with Constipation-predominant Irritable Bowel Syndrome: A Parallel-group Trial

“…In contrast, patients with severe IBS symptoms in the absence of organic disease could be subjected to unnecessary repeated tests. 13,51 Therefore, more reliable objective biomarkers are needed to supplement pathophysiologic disease status to assess the efficacy of certain therapies and avoid unnecessary invasive tests with unintended procedurerelated adverse effects. Objective biomarkers have been evaluated based on pathophysiologic mechanisms of IBS.…”

“…1,10 IBS has been attributed to GI sensory-motor dysfunction, such as intestinal dysmotility, visceral hypersensitivity, intestinal bacterial overgrowth, inflammation, food sensitivity or intolerance, genetic factors, and psychosocial dysfunction. 3,[11][12][13] Recent evidence suggests that alterations in the brain-gut axis play an important role in IBS, 14,15 including altered sympathetic and parasympathetic activities of the autonomic nervous system (ANS). 16 Similarly, patients with IBS are known to have a higher occurrence of mood disturbances, anxiety, depression, somatization disorders, and psychological distress, 15,17 and the central nervous system (CNS) is believed to be involved in the concomitance of these conditions.…”

Dumping Syndrome: A Review of the Current Concepts of Pathophysiology, Diagnosis, and Treatment

“…Patients with IBS should be questioned regarding the Rome III diagnostic criteria of IBS. According to Rome III, IBS is suggested after at least 3 months of episodic abdominal pain, provided two of the next three criteria are present: Changes in the stool consistency are present, changes in stooling frequency are present, and abdominal pain is relieved by defecation [7].…”

Systemic cytokines are elevated in a subset of patients with irritable bowel syndrome but largely unrelated to symptom characteristics

“…Approximately 5%‐15% of adults in the western world are afflicted with this combination of gastrointestinal (GI) symptoms and are diagnosed with IBS . Irritable bowel syndrome patients have a recognized heterogeneity and differ in aspects such as severity and constellation of symptoms, abruptness of onset and possible triggers, making effective subgrouping a challenging but necessary task …”