About 10–15% of people in thedeveloped world are believed to be affected by IBS.[1][12] The prevalence varies according to country (from 1.1% to 45.0%) and criteria used to define IBS; the average global prevalence is 11.2%.[13] It is more common inSouth America and less common inSoutheast Asia.[7] In theWestern world, it is twice as common in women as men and typically occurs before age 45.[1] However, women inEast Asia are not more likely than their male counterparts to have IBS, indicating much lower rates among East Asian women.[22] Similarly, men from South America, South Asia and Africa are just as likely to have IBS as women in those regions, if not more so.[23] The condition appears to become less common with age.[7] IBS does not affect life expectancy or lead to other serious diseases.[11] The first description of the condition was in 1820, while the current termirritable bowel syndrome came into use in 1944.[24]
The primary symptoms of IBS areabdominal pain or discomfort in association with frequent diarrhea or constipation and a change in bowel habits.[25] Symptoms usually are experienced as acute attacks that subside within one day, but recurrent attacks are likely.[26] There may also be urgency for bowel movements, a feeling of incomplete evacuation (tenesmus) or bloating.[27] In some cases, the symptoms are relieved bybowel movements.[21]
By definition, the symptoms of IBS are chronic (having been present for at least 6 months based on Rome IV diagnostic criteria).[30] Symptoms such as unexplained weight loss, rectal bleeding, recent changes in bowel habits, anemia or iron deficiency are usually not due to IBS and warrant additional testing.[30] Some people with IBS with constipation also havepelvic floor dysfunction, which may present as needing to manually disimpact stool during bowel movements, or bladder symptoms such as incomplete bladder emptying, urination at night (nocturia), increased urinary frequency or frequent urinary tract infections.[30]
Recent findings suggest that anallergy-triggered peripheral immune mechanism may underlie the symptoms associated with abdominal pain in patients with irritable bowel syndrome.[33] Studies showed that a considerable portion of patients with IBS experience immediate mucosal responses to certain foods. These responses, observed through fluorescein leakage and cell shedding duringConfocal endoscopy, were linked to significant symptom relief in more than 70% of patients following customized dietary restrictions. This implies that localized immune reactions and compromised barrier function, beyond traditional IgE-mediated allergies, might play a role in IBS symptoms.[34]
People who are younger than 50, women, and those with a family history of the condition are more likely to develop IBS.[35] Further risk factors areanxiety,depression, andstress.[36] The risk of developing IBS increases six-fold after having a gastrointestinal infection (gastroenteritis).[35] This is also calledpost-infectious IBS. The risk of developing IBS following an infection is further increased in those who also had a prolonged fever during the illness.[37] Antibiotic use also appears to increase the risk of developing IBS.[38] Genetic defects ininnate immunity andepithelial homeostasis increase the risk of developing both post-infectious as well as other forms of IBS.[39]
The role of the brain–gut axis in IBS has been suggested since the 1990s[4] and childhood physical and psychological abuse is often associated with the development of IBS.[6] It is believed that psychological stress may trigger IBS in predisposed individuals.[3]
Given the high levels of anxiety experienced by people with IBS and the overlap with conditions such asfibromyalgia andchronic fatigue syndrome, a potential explanation for IBS involves a disruption of the stress system. The stress response in the body involves thehypothalamic–pituitary–adrenal axis (HPA) and thesympathetic nervous system, both of which have been shown to operate abnormally in people with IBS. Psychiatric illness or anxiety precedes IBS symptoms in two-thirds of people with IBS, and psychological traits predispose previously healthy people to developing IBS after gastroenteritis.[40][41] Individuals with IBS also report high rates of sleep disturbances such as trouble falling asleep and frequent arousal throughout the night.[42]
Approximately 10 percent of IBS cases are triggered by an acutegastroenteritis infection.[43] TheCdtB toxin is produced by bacteria causing gastroenteritis and the host may develop anautoimmunity when host antibodies to CdtB cross-react withvinculin.[44] Genetic defects relating to theinnate immune system and epithelial barrier as well as high stress and anxiety levels appear to increase the risk of developing post-infectious IBS. Post-infectious IBS usually manifests itself as the diarrhea-predominant subtype. Evidence has demonstrated that the release of high levels of proinflammatory cytokines during acute enteric infection causes increasedgut permeability leading totranslocation of thecommensal bacteria across theepithelial barrier; this in turn can result in significant damage to local tissues, which can develop into chronic gut abnormalities in sensitive individuals. However, increased gut permeability is strongly associated with IBS regardless of whether IBS was initiated by an infection or not.[39] A link betweensmall intestinal bacterial overgrowth andtropical sprue has been proposed to be involved as a cause of post-infectious IBS.[45]
Small intestinal bacterial overgrowth (SIBO) occurs with greater frequency in people who have been diagnosed with IBS compared to healthy controls.[46] SIBO is most common in diarrhea-predominant IBS but also occurs in constipation-predominant IBS more frequently than healthy controls. Symptoms of SIBO include bloating, abdominal pain, diarrhea or constipation among others. IBS may be the result of the immune system interacting abnormally with gut microbiota resulting in an abnormalcytokine signalling profile.[47]
Certain bacteria are found in lower or higher abundance when compared with healthy individuals. GenerallyBacteroidota,Bacillota, andPseudomonadota are increased andActinomycetota,Bifidobacteria, andLactobacillus are decreased. Within the human gut, there are common phyla found. The most common is Bacillota. This includesLactobacillus, which is found to have a decrease in people with IBS, andStreptococcus, which is shown to have an increase in abundance. Within this phylum, species in the classClostridia are shown to have an increase, specificallyRuminococcus andDorea. The familyLachnospiraceae presents an increase in IBS-with-diarrhea (IBS-D) patients. The second most common phylum is Bacteroidota. In people with IBS, the Bacteroidota phylum has been shown to have an overall decrease, but an increase in the genusBacteroides. IBS-D shows a decrease for the phylum Actinomycetota and an increase in Pseudomonadota, specifically in the familyEnterobacteriaceae.[48]
Alterations ofgut microbiota (dysbiosis) are associated with the intestinal manifestations of IBS, but also with the psychiatric morbidity that coexists in up to 80% of people with IBS.[49]
Studies in patients with IBS have shown notable changes in gutmicrobiota, including increases inClostridia andEscherichia coli, along with reductions inBacteroidia,Lactobacillus species, andBifidobacterium species. Many patients also display a higherFirmicutes toBacteroidetes ratio and reduced overall microbial diversity.The intricate relationship between intestinal microbes and the gut–brain axis has led to the emerging concept of a microbiota–gut–brain axis. Evidence supporting therapies that modify the microbiome remains mixed; antibiotics, probiotics, and prebiotics have documented roles, whilefecal microbiota transplantation is still largely confined to research. Important questions remain, including what constitutes the optimal microbiome profile for fecal donor in patients with IBS.[50]
Prevalence of protozoal infections in industrialized countries (United States and Canada) in the 21st century[51][52]
Protozoal infections can cause symptoms that mirror specific IBS subtypes,[53] e.g., infection by certain substypes ofBlastocystis hominis (blastocystosis).[54][55] Many people regard these organisms as incidental findings, and unrelated to symptoms of IBS.
Blastocystis andDientamoeba fragilis colonisation occurs more commonly in IBS affected individuals but their role in the condition is unclear.[56]
Vitamin D deficiency is more common in individuals affected by IBS.[57][58] Vitamin D is involved in regulating triggers for IBS including the gut microbiome, inflammatory processes and immune responses, as well as psychosocial factors.[59]
SCN5Amutations are found in a small number of people who have IBS, particularly the constipation-predominant variant (IBS-C).[60][61] The resulting defect leads to disruption in bowel function, by affecting theNav1.5 channel, in smooth muscle of the colon and pacemaker cells.[62][63][64]
Genetic, psychological, and especially environmental factors all seem to be important in the development of IBS.[67]
Dysregulated brain-gut axis, abnormalserotonin/5-hydroxytryptamine (5-HT) metabolism, and high density of mucosalnerve fibers in the intestines have been implicated in the mechanisms of IBS. A number of5-HT receptor subtypes were involved in the IBS symptoms, including5-HT3,5-HT4, and5-HT7 receptors. High levels of 5-HT7 receptor-expressing mucosal nerve fibers were observed in the colon of IBS patients. A role of5-HT7 receptor in intestinalhyperalgesia was demonstrated in mouse models withvisceral hypersensitivity, of which a novel 5-HT7 receptor antagonist administered by mouth reduced intestinal pain levels.[68]
Abnormalities occur in the gut flora of individuals who have IBS, such as reduced diversity, a decrease in bacteria belonging to the phylumBacteroidota, and an increase in those belonging to the phylumBacillota.[49] The changes in gut flora are most profound in individuals who have diarrhoea-predominant IBS. Antibodies against common components (namelyflagellin) of the commensal gut flora are a common occurrence in IBS affected individuals.[69]
Chronic low-grade inflammation commonly occurs in IBS affected individuals with abnormalities found including increasedenterochromaffin cells,intraepithelial lymphocytes, andmast cells resulting in chronic immune-mediated inflammation of the gut mucosa.[31][70] IBS has been reported in greater quantities in multigenerational families with IBS than in the regular population.[71] It is believed that psychological stress can induce increased inflammation and thereby cause IBS to develop in predisposed individuals.[3]
No specific laboratory or imaging tests can diagnose irritable bowel syndrome. Diagnosis should be based on symptoms, the exclusion of worrisome features, and the performance of specific investigations to rule out organic diseases that may present similar symptoms.[7][72]
The recommendations for physicians are to minimize the use of medical investigations.[73] TheRome criteria are typically used for diagnosis. They allow the diagnosis to be based only on symptoms, but no criteria based solely on symptoms is sufficiently accurate to diagnose IBS.[74][75] Worrisome features include onset at greater than 50 years of age, weight loss,blood in the stool,iron-deficiency anemia, or a family history ofcolon cancer,celiac disease, orinflammatory bowel disease.[7] The criteria for selecting tests and investigations also depends on the level of available medical resources.[76]
The Rome IV criteria for diagnosing IBS include recurrent abdominal pain, on average, at least one day/week in the last three months, associated with additional stool- or defecation-related criteria.[77] The algorithm may include additional tests to guard against misdiagnosis of other diseases as IBS. Such "red flag" symptoms that may indicate other diseases as well include weight loss, gastrointestinal bleeding, anemia, or nocturnal symptoms. However, red flag conditions may not always contribute to accuracy in diagnosis; for instance, as many as 31% of people with IBS have blood in their stool, many possibly fromhemorrhoidal bleeding.[78]
Ruling out parasitic infections,lactose intolerance, small intestinal bacterial overgrowth, and celiac disease is recommended before a diagnosis of IBS is made.[72] Anupper endoscopy withsmall bowelbiopsies is necessary to identify the presence of celiac disease.[80] An ileocolonoscopy with biopsies is useful to excludeCrohn's disease andulcerative colitis (Inflammatory bowel disease).[80]
Several medical conditions, orcomorbidities, appear with greater frequency in people with IBS.
Neurological/psychiatric: A study of 97,593 individuals with IBS identified comorbidities such as headache, fibromyalgia, and depression.[95] IBS occurs in 51% of people with chronic fatigue syndrome and 49% of people with fibromyalgia, and psychiatric disorders occur in 94% of people with IBS.[15][note 1]
Channelopathy andmuscular dystrophy: IBS and functional GI diseases are comorbidities of genetic channelopathies that cause cardiac conduction defects and neuromuscular dysfunction, and result also in alterations in GI motility, secretion, and sensation.[96] Similarly, IBS and FBD are highly prevalent inmyotonic muscle dystrophies. Digestive symptoms may be the first sign of dystrophic disease and may precede the musculo-skeletal features by up to 10 years.[97]
Inflammatory bowel disease: IBS may be marginally associated with inflammatory bowel disease.[98] Researchers have found some correlation between IBS and IBD,[99] noting that people with IBD experience IBS-like symptoms when their IBD is in remission.[100][101] A three-year study found that patients diagnosed with IBS were 16.3 times more likely to be diagnosed with IBD during the study period, although this is likely due to an initial misdiagnosis.[102][non-primary source needed]
Abdominal surgery: People with IBS were at increased risk of having unnecessarygall bladder removal surgery not due to an increased risk ofgallstones, but rather toabdominal pain, awareness of having gallstones, and inappropriate surgical indications.[103] These people also are 87% more likely to undergo abdominal and pelvic surgery and three times more likely to undergo gallbladder surgery.[104] Also, people with IBS were twice as likely to undergo hysterectomy.[105]
Endometriosis: One study reported a statistically significant link betweenmigraine headaches, IBS, and endometriosis.[106]
Other chronic disorders:Interstitial cystitis may be associated with other chronic pain syndromes, such as irritable bowel syndrome and fibromyalgia. The connection between these syndromes is unknown.[107]
IBS can be classified asdiarrhea-predominant (IBS-D),constipation-predominant (IBS-C), with mixed/alternating stool pattern (IBS-M/IBS-A) or pain-predominant.[108] In some individuals, IBS may have an acute onset and develop after aninfectious illness characterized by two or more of: fever, vomiting, diarrhea, or positivestool culture. This post-infective syndrome has consequently been termed "post-infectious IBS" (IBS-PI).[109][110][111][112]
There is evidence that a dietitian-supervisedlow-FODMAP diet is the best diet to control IBS symptoms among the studied dietary recommendations, though there is a lack of evidence on possibleadverse effects.[116][117]
TheNational Institute for Health and Care Excellence (NICE) recommends a low-FODMAP diet for the treatment of IBS if symptoms persist despite general dietary and lifestyle changes, but they state that such a diet must be administered only by a healthcare professional with dietary training[118] and it should be not considered as the only therapeutic approach to patients with IBS.[119]
The use of a low-FODMAP diet without verifying the diagnosis of IBS may result in misdiagnosis of other conditions such as celiac disease.[120] Since the consumption ofgluten is suppressed or reduced with a low-FODMAP diet, the improvement of the digestive symptoms with this diet may not be related to the withdrawal of the FODMAPs, but of gluten, indicating the presence of unrecognized celiac disease, avoiding its diagnosis and correct treatment, with the consequent risk of several serious health complications, including various types of cancer.[120][121]
Solublefiber supplementation (e.g.,psyllium/ispagula husk) may be effective in improving symptoms.[19] However soluble fiber does not appear to reduce pain.[122] It acts as a bulking agent, and for many people with IBS-D, allows for a more consistent stool. For people with IBS-C, it seems to allow for a softer, moister, more easily passable stool.[citation needed]
However, insoluble fiber (e.g.,bran) is not effective for IBS.[123][124] In some people, insoluble fiber supplementation may aggravate symptoms.[125][126]
Fiber might be beneficial in those who have a predominance of constipation. In people who have IBS-C, soluble fiber can reduce overall symptoms but will not reduce pain. The research supporting dietary fiber contains conflicting small studies complicated by the heterogeneity of types of fiber and doses used.[122]
Physical activity can have beneficial effects on irritable bowel syndrome.[127] In light of this, the latest British Society of Gastroenterology guidelines on the management of IBS have stated that all patients with IBS should be advised to take regular exercise (strong recommendation, weak certainty evidence),[128]Physical activity could lead to a significant clinical benefit for symptoms of irritable bowel syndrome.[127]
Yoga may improve gastrointestinal symptoms, decrease anxiety and depression, and enhance quality of life in patients with IBS.[129][130]
Medications that may be useful include antispasmodics such asdicyclomine andantidepressants.[131] Both H1-antihistamines andmast cell stabilizers have shown efficacy in reducing pain associated withvisceral hypersensitivity in IBS.[31] There is a link between mast cell activity and IBS pain: people with IBS exhibit increased mucosal mast cells, elevated tryptase/histamine, and enhanced proximity of degranulating mast cells to enteric nerves, each correlating with subjective pain scores; tricyclic antidepressants that have mast-cell stabilizing effects (such as amitriptyline) are believed to help not simply by altering mood, but by reducing visceral afferent firing, possibly through attenuation of nerve-mast cell crosstalk.[132][133]
A number of5-HT3 antagonists or 5-HT4 agonists were proposed clinically to treat diarrhea-predominant IBS and constipation-predominant IBS, respectively. However, severe side effects have resulted in its withdrawal by Food and Drug Administration and are now prescribed under emergency investigational drug protocol.[134] Other 5-HT receptor subtypes, such as5-HT7 receptor, have yet to be developed.[medical citation needed]
For people who do not adequately respond to dietary fiber, osmoticlaxatives such aspolyethylene glycol,sorbitol, andlactulose can help avoid "cathartic colon" which has been associated with stimulant laxatives.[135]Lubiprostone is a gastrointestinal agent used for the treatment of constipation-predominant IBS.[136]
The use ofantispasmodic drugs (e.g.,anticholinergics such ashyoscyamine ordicyclomine) may help people who have cramps or diarrhea. A meta-analysis by theCochrane Collaboration concludes that one out of seven people benefit from treatment with antispasmodics.[131] Antispasmodics can be divided into two groups: neurotropics and musculotropics. Musculotropics, such asmebeverine, act directly at the smooth muscle of the gastrointestinal tract, relieving spasm without affecting normal gut motility.[citation needed] Since this action is not mediated by the autonomic nervous system, the usual anticholinergic side effects are absent.[137] The antispasmodicotilonium may also be useful.[138]
Proton-pump inhibitors (PPIs) used to suppress stomach acid production may causesmall intestinal bacterial overgrowth (SIBO) leading to IBS symptoms.[139] Discontinuation of PPIs in selected individuals has been recommended as it may lead to an improvement or resolution of IBS symptoms.[140]
Evidence is conflicting about the benefit ofantidepressants in IBS. Some meta-analyses have found a benefit, while others have not.[141] There is good evidence that low doses oftricyclic antidepressants (TCAs) can be effective for IBS.[131][142] With TCAs, about one in three people improve.[143]
However, the evidence is less robust for the effectiveness of other antidepressant classes such asselective serotonin reuptake inhibitor antidepressants (SSRIs). Because of their serotonergic effect, SSRIs have been studied in IBS, especially for people who are constipation predominant. As of 2015, the evidence indicates that SSRIs do not help.[144] Antidepressants are not effective for IBS in people with depression, possibly because lower doses of antidepressants than the doses used to treat depression are required for relief of IBS.[145]
Rifaximin may be useful as a treatment for IBS symptoms, including abdominal bloating and flatulence, although relief ofabdominal distension is delayed.[3][147] It is especially useful where small intestinal bacterial overgrowth is involved.[3]
In individuals with IBS and low levels ofvitamin D, supplementation is recommended. Some evidence suggests that vitamin D supplementation may improve symptoms of IBS, but further research is needed before it can be recommended as a specific treatment for IBS.[57][58]
There is inconsistent evidence from studies with poor methodological quality that psychological therapies can be effective in the treatment of IBS.[145] Preliminary research shows that psychotherapeutic interventions are correlated with reductions in bothautonomic nervous system dysregulation and gastrointestinal symptoms.[42] Reducing stress may also reduce the frequency and severity of IBS symptoms. Techniques that may be helpful include regular exercise, such as swimming, walking, or running.[148]
Probiotics can be beneficial in the treatment of IBS; taking 10 billion to 100 billion beneficial bacteria per day is recommended for beneficial results. However, individual strains of beneficial bacteria are not well enough understood for more refined recommendations.[147][149] Probiotics have positive effects such as enhancing theintestinal mucosal barrier, providing a physical barrier,bacteriocin production (resulting in reduced numbers of pathogenic and gas-producing bacteria), reducing intestinal permeability and bacterial translocation, and regulating the immune system both locally and systemically among other beneficial effects.[87] Probiotics may also have positive effects on thegut–brain axis by their positive effects countering the effects of stress on gut immunity and gut function.[150]
A number of probiotics have been found to be effective, includingLactobacillus plantarum,[87] andBifidobacteria infantis;[151] but one review found onlyBifidobacteria infantis showed efficacy.[152]B. infantis may have effects beyond the gut via it causing a reduction of proinflammatory cytokine activity and elevation of bloodtryptophan levels, which may cause an improvement in symptoms of depression.[153] Someyogurt is made using probiotics that may help ease symptoms of IBS.[154] A probiotic yeast calledSaccharomyces boulardii has some evidence of effectiveness in the treatment of irritable bowel syndrome.[155]
Certain probiotics have different effects on certain symptoms of IBS. For example,Bifidobacterium breve,B. longum, andLactobacillus acidophilus have been found to alleviate abdominal pain.B. breve, B. infantis, L. casei, orL. plantarum species alleviateddistension symptoms.B. breve, B. infantis, L. casei, L. plantarum, B. longum, L. acidophilus, L. bulgaricus, andStreptococcus salivarius ssp.thermophilus have all been found to affect flatulence levels. Most clinical studies show probiotics do not improve straining, sense of incomplete evacuation, stool consistency, fecal urgency, or stool frequency, although a few clinical studies did find some benefit of probiotic therapy.[156]The evidence is conflicting for whether probiotics improve overall quality of life scores.[157]
Probiotics may exert their beneficial effects on IBS symptoms via preserving the gut microbiota, normalisation of cytokine blood levels, improving the intestinal transit time, decreasing small intestine permeability, and by treatingsmall intestinal bacterial overgrowth of fermenting bacteria.[157] Afecal transplant does not appear useful as of 2019.[158]
Peppermint oil appears useful.[159] In a meta-analysis it was found to be superior to placebo for improvement of IBS symptoms, at least in the short term.[115] An earlier meta-analysis suggested the results of peppermint oil were tentative as the number of people studied was small and blinding of those receiving treatment was unclear.[113] Safety during pregnancy has not been established, however, and caution is required not to chew or break theenteric coating; otherwise,gastroesophageal reflux may occur as a result oflower esophageal sphincter relaxation. Occasionally, nausea and perianal burning occur as side effects.[124]Iberogast, a multi-herbal extract, was found to be superior in efficacy to placebo.[160] A comprehensive meta-analysis using twelve random trials resulted that the use of peppermint oil is an effective therapy for adults with irritable bowel syndrome.[161]
Research intocannabinoids as treatment for IBS is limited. GI propulsion, secretion, and inflammation in the gut are all modulated by theECS (Endocannabinoid system), providing a rationale for cannabinoids as treatment candidates for IBS.[162]
Only limited evidence exists for the effectiveness of other herbal remedies for IBS. As with all herbs, it is wise to be aware of possible drug interactions and adverse effects.[124]
Percentage of population with IBS reported in various studies in different countries (see sources in the table)
The prevalence of IBS varies by country and by age range examined. The bar graph at right shows the percentage of the population reporting symptoms of IBS in studies from various geographic regions (see table below for references). The following table contains a list of studies performed in different countries that measured the prevalence of IBS and IBS-like symptoms:
Percentage of population reporting symptoms of IBS in various studies from various geographic areas
InWestern countries, women are around two to three times more likely to be diagnosed with IBS and four to five times more likely to seek specialty care for it than men.[172] However, women in East Asian countries are not more likely than men to have irritable bowel syndrome, and there are conflicting reports about the female predominance of the disease in Africa and other parts of Asia.[173] People diagnosed with IBS are usually younger than 45 years old.[1] Studies of females with IBS show symptom severity often fluctuates with the menstrual cycle, suggesting hormonal differences may play a role.[174] Endorsement of gender-related traits has been associated with quality of life and psychological adjustment in IBS.[175] The increase in gastrointestinal symptoms during menses or early menopause may be related to declining or low estrogen and progesterone, suggesting that estrogen withdrawal may play a role in IBS.[176] Gender differences in healthcare-seeking may also play a role.[177] Gender differences in trait anxiety may contribute to lower pain thresholds in women, putting them at greater risk for a number of chronic pain disorders.[178] Finally, sexual trauma is a major risk factor for IBS, as are other forms of abuse.[179] Because women are at higher risk of sexual abuse than men, sex-related risk of abuse may contribute to the higher rate of IBS in women.[180]
The concept of an "irritable bowel" was introduced byP. W. Brown, first inThe Journal of the Kansas Medical Society in 1947[181] and later in theRocky Mountain Medical Journal in 1950.[182] The term was used to categorize people who developed symptoms of diarrhea, abdominal pain, and constipation, but where no well-recognized infective cause could be found. Early theories suggested the irritable bowel was caused by a psychosomatic or mental disorder.[182] World IBS Day was founded on April 19th, 2019 and is celebrated annually in order to raise awareness about Irritable Bowel Syndrome.[183] In some locations World IBS Day is also called World IBS Awareness Day. World Irritable Bowel Syndrome Day or simply IBS Awareness Day.[184]
The aggregate cost of irritable bowel syndrome in the United States has been estimated at $1.7–10 billion in direct medical costs, with an additional $20 billion in indirect costs, for a total of $21.7–30 billion.[14] A study by a managed care company comparing medical costs for people with IBS to non-IBS controls identified a 49% annual increase in medical costs associated with a diagnosis of IBS.[185] People with IBS incurred average annual direct costs of $5,049 and $406 in out-of-pocket expenses in 2007.[186] A study of workers with IBS found that they reported a 34.6% loss in productivity, corresponding to 13.8 hours lost per 40 hour week.[187] A study of employer-related health costs from a Fortune 100 company conducted with data from the 1990s found people with IBS incurred US$4527 in claims costs vs. $3276 for controls.[188] A study on Medicaid costs conducted in 2003 by theUniversity of Georgia College of Pharmacy andNovartis found IBS was associated in an increase of $962 in Medicaid costs in California, and $2191 in North Carolina. People with IBS had higher costs for physician visits, outpatients visits, and prescription drugs. The study suggested the costs associated with IBS were comparable to those found for people with asthma.[189]
Individuals with IBS have been found to have decreased diversity and numbers ofBacteroidota microbiota. Preliminary research into the effectiveness offecal microbiota transplant in the treatment of IBS has been very favourable with a 'cure' rate of between 36 percent and 60 percent with remission of core IBS symptoms persisting at 9 and 19 months follow up.[190][191] Treatment with probiotic strains of bacteria has shown to be effective, though not all strains of microorganisms confer the same benefit and adverse side effects have been documented in a minority of cases.[192]
There is increasing evidence for the effectiveness ofmesalazine (5-aminosalicylic acid) in the treatment of IBS.[193] Mesalazine is a drug withanti-inflammatory properties that has been reported to significantly reduce immune mediated inflammation in the gut of IBS affected individuals with mesalazine therapy resulting in improved IBS symptoms as well as feelings of general wellness in IBS affected people. It has also been observed that mesalazine therapy helps to normalise the gut flora which is often abnormal in people who have IBS. The therapeutic benefits of mesalazine may be the result of improvements to theepithelial barrier function.[194] Treatment or exclusion diet based on "abnormally" highIgG antibodies cannot be recommended.[195][119]
Differences in visceral sensitivity and intestinal physiology have been noted in IBS. Mucosal barrier reinforcement in response to oral5-HTP was absent in IBS compared to controls.[196] IBS/IBD individuals are less oftenHLA DQ2/8 positive than in upper functional gastrointestinal disease and healthy populations.[197]
Efficacy ofmast cell directed therapies in irritable bowel syndrome is an area of ongoing research.[198]
Increasing research continues to suggest several biomarkers and lack of microbiome diversity that may be associated with IBS, its subtype and severity. These biomarkers reflect the dynamic relationship between the gut, brain, and immune system, often referred to as the gut–brain axis. The absence of specific laboratory biomarkers means that IBS is largely a diagnosis of exclusion. This can lead to diagnostic uncertainty, delayed management, and inconsistent treatment application in clinical practices. Thus, there is an apparent need for consistent, objective diagnostic tools that can support or replace symptom- based diagnosis.
Anti-neuronal antibodies (ANAs) also known as anti-enteric neuronal antibodies (AENAs) which can target the enteric nervous system have emerged as a potential area of interest. ANAs are immune proteins that recognize neuronal components on the cell surface or intracellularly, leading to neuronal dysfunction or cell death. While commonly associated with paraneoplastic neurological syndromes such as anti-Hu (ANNA-1) found in small-cell lung carcinoma suggest that ANAs can also occur independently of cancer and contribute to dysregulation in functional disorders like IBS[198]. Growing evidence further explain ANA activity is present in non-neoplastic disorders affecting the enteric nervous system[197]. Although biomarker testing is yet to be a reliable diagnostic tool for IBS, it shows promising clinical value. For example, in a study of 293 patients, human SH-Sy5Y cells exposed to serum from ANA (+) IBS patients exhibited increased apoptosis compared to the control group. The TUNEL assay, which detects DNA fragmentation confirmed these findings (Höftberger et al., 2012). These findings further support the potential for biomarker screening to development into a diagnostic too for the diagnose of IBS and its subtypes.
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