Marshall and Warren Lecture 2019: A paradigm shift in pathophysiological basis of irritable bowel syndrome and its implication on treatment

Abstract

Irritable bowel syndrome (IBS), a common functional gastrointestinal disorder (FGID), has often been considered rather inappropriately as psychogenic in the past. Though psychological issues are important comorbidities in a proportion of IBS patients, the evidences are far from enough to label this condition as psychogenic only. In the recent past, evidences are emerging that underscores the concept supporting pure psychogenic theory of IBS and suggest this disorder to be rather microorganic. Accordingly, a move of Rome IV Committee attempting to delete the term "functional" and designating these to be disorders of "gut-brain interaction" rather than that of "brain-gut interaction," it emphasizes the importance of the gut over the brain in the pathogenesis. The introduction of the concept of multidimensional clinical profile in Rome IV requires attention to diagnostic category of FGID, overlap, severity, psychological issues, and physiological dysfunction or biomarkers; this attempts to recognize clinical variability and multidimensionality of pathophysiology and management of these disorders. The recognition of the biological factors in the pathogenesis of IBS is a significant paradigm shift in the recent time. This is somewhat similar to the progress in the pathogenesis of peptic ulcer disease from psychological factor to acid to Helicobacter pylori infection. It is expected that in the near future, therapeutic modalities targeting the different pathogenic mechanisms of different subtypes of IBS may bring revolution in management of the disorder.

Psychological issues in patients with irritable bowel syndrome: Throwing more light is necessary

“…As reported in the literature [3], the authors also found that the female students more often had IBS than male students. Since the authors also found subjects with DGBIs, including IBS, had anxiety and depression more often, the data on these psychological parameters among female and male subjects should be provided.…”

“…Overlap FGIDs are known to be associated with more severe disease, poorer quality of life, consultation behavior, psychological comorbidity, and an unsatisfactory response to treatment in comparison to a single disorder [3]. However, the authors did not provide the data on the frequency and mean or median (with standard deviation or range) scores of Hamilton anxiety and depression rating scales of subjects with single compared to overlap FGIDs.…”

Blasenkarzinom − Komplikationen der Harnableitung

“…Zu langfristigen Darmbeschwerden nach radikaler Zystektomie gibt es wenig validierte Daten, entsprechend liegen auch speziell für diese Situation keine evidenzbasierten Empfehlungen für eine mögliche Therapie vor. Ein möglicher Ansatz ist es bei den Patienten, die durch funktionelle Darmbeschwerden belastet sind, ähnlich wie bei der Diagnostik des Reizdarmsyndroms ("irritable bowel syndrome (IBS)") vorzugehen [52]. Hier werden die Beschwerden anhand definierter Diagnosekriterien (ROME IV criteria) zunächst in Obstipationsund Diarrhö-artige Symptome eingeteilt; anschließend erfolgt eine differenzialdiagnostische Abklärung möglicher Ursachen (die zugegebenermaßen mannigfaltig sind).…”

Blasenkarzinom − Komplikationen der Harnableitung

“…Zu langfristigen Darmbeschwerden nach radikaler Zystektomie gibt es wenig validierte Daten, entsprechend liegen auch speziell für diese Situation keine evidenzbasierten Empfehlungen für eine mögliche Therapie vor. Ein möglicher Ansatz ist es, bei den Patienten, die durch funktionelle Darmbeschwerden belastet sind, ähnlich wie bei der Diagnostik des Reizdarmsyndroms ("irritable bowel syndrome", IBS) vorzugehen [52]. Hier werden die Beschwerden anhand definierter Diagnosekriterien (ROME IV criteria) zunächst in Obstipations-und Diarrhö-artige Symptome eingeteilt; anschließend erfolgt eine differenzialdiagnostische Abklärung möglicher Ursachen (die zugegebenermaßen mannigfaltig sind).…”