Pathogenesis of Irritable Bowel Syndrome: Is It Really in the Gene?

Ghoshal, Uday C; Singh, Rajan

doi:10.5056/jnm14071

Cited by 7 publications

(4 citation statements)

References 45 publications

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“…These factors may be broadly classified into (i) peripheral factors 17 (viz., altered gastrointestinal [GI] motility, GI inflammation and permeability alteration, altered luminal microenvironment including gut microbiota dysbiosis and small intestinal bacterial overgrowth [SIBO], host–microbe interaction, bile acid recirculation defect, pathogenic infection, dietary factors, and neurohumoral dysregulation including altered serotonergic transmission and visceral hypersensitivity) and (ii) central factors (psychological stress, cognitive dysfunction, abnormal emotional arousal system response, and sleep dysfunction). Genetic factors may underlie peripheral and central pathophysiological mechanisms 18 . As listed above, a greater number of factors involved in the pathogenesis of IBS are peripheral rather than central in nature.…”

Section: Factors Implicated In the Pathogenesis Of Irritable Bowel Symentioning

confidence: 99%

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

Ghoshal

2020

J of Gastro and Hepatol

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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.

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Section: Factors Implicated In the Pathogenesis Of Irritable Bowel Symentioning

confidence: 99%

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

Ghoshal

2020

J of Gastro and Hepatol

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“…Polymorphisms in several genes involved inflammation, immune regulation, antigen recognition, defense mechanisms, tissue repair, neuro-transmission, lactose malabsorption etc have been studied in Asia. 118 However, most of these studies suffer from limitation due to inadequate power resulting from relatively small sample size. The Rome IV criteria eliminated the term "discomfort" to reduce ambiguity and improve consistency of the criteria across different languages.…”

Section: Team 2: Pathophysiologymentioning

confidence: 99%

Second Asian Consensus on Irritable Bowel Syndrome

Gwee

Gonlachanvit

Ghoshal

et al. 2019

J Neurogastroenterol Motil

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Background/Aims There has been major progress in our understanding of the irritable bowel syndrome (IBS), and novel treatment classes have emerged. The Rome IV guidelines were published in 2016 and together with the growing body of Asian data on IBS, we felt it is timely to update the Asian IBS Consensus. Methods Key opinion leaders from Asian countries were organized into 4 teams to review 4 themes: symptoms and epidemiology, pathophysiology, diagnosis and investigations, and lifestyle modifications and treatments. The consensus development process was carried out by using a modified Delphi method. Results Thirty-seven statements were developed. Asian data substantiate the current global viewpoint that IBS is a disorder of gut-brain interaction. Socio-cultural and environmental factors in Asia appear to influence the greater overlap between IBS and upper gastrointestinal symptoms. New classes of treatments comprising low fermentable oligo-, di-, monosacharides, and polyols diet, probiotics, non-absorbable antibiotics, and secretagogues have good evidence base for their efficacy. Conclusions Our consensus is that all patients with functional gastrointestinal disorders should be evaluated comprehensively with a view to holistic management. Physicians should be encouraged to take a positive attitude to the treatment outcomes for IBS patients.

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“…IBS may have a genetic component, as indicated by twin studies that have demonstrated a higher concordance rate in monozygotic twins compared to dizygotic twins [ 33 - 35 ]. Among the genes investigated, the serotonin transporter gene polymorphism (5-HTTLPR) has been one of the most extensively studied in relation to IBS [ 36 - 39 ]. However, the findings of these studies have yielded conflicting results [ 37 ].…”

Section: P Athophysiologymentioning

confidence: 99%

Update in diagnosis and management of irritable bowel syndrome

Hung,

Wang,

Lee

2023

Tzu Chi Medical Journal

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Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by a lack of structural or biochemical abnormalities. The current diagnosis of IBS is based on the Rome IV criteria, and it is recommended to approach IBS patients using a multidimensional clinical profile (MDCP). The pathophysiology of IBS is multifactorial and involves motility disorders, genetic factors, immune responses, visceral hypersensitivity, brain–gut dysregulation, and altered intestinal microbiota. The management of IBS includes both nonpharmacologic and pharmacologic therapies. Nonpharmacologic therapy options include physical activity, low fermentable oligosaccharides, disaccharides, monosaccharides, and polyol diet, as well as cognitive behavioral therapy. Pharmacologic therapy options include probiotics, antidepressants, antispasmodics, and new agents. In clinical practice, a multidisciplinary strategy, including nonpharmacologic or/and pharmacologic treatment for IBS, is emphasized. Therefore, clinicians should carefully consider the underlying pathophysiology before selecting an appropriate therapeutic option for the treatment of IBS. In other words, individualized treatment plans are necessary for managing IBS.

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Pathogenesis of Irritable Bowel Syndrome: Is It Really in the Gene?

Cited by 7 publications

References 45 publications

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

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

Second Asian Consensus on Irritable Bowel Syndrome

Update in diagnosis and management of irritable bowel syndrome

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