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Mechanisms behind IBS

In this chapter, I go over the different mechanisms that have been suggested by experts to lead to IBS symptoms

IBS has long been considered a functional gut disorder. Now the classification is being changed to a “disorder of gut-brain interaction”. The new classification of IBS tells us that the problem that leads to gut symptoms is in the communication between the gut and the brain, which suggests also that symptom relief is possible through fixing this communication problem. Stress and the “fight-or-flight” response can trigger this dysfunctional communication, and when digging into the causes of the mechanisms I will write about in the topics below, stress shows up as being able to cause all of the proposed mechanisms. Perhaps IBS is not really a functional disorder after all – research is showing that there are actual (though not very testable) changes in the gut that lead to gut symptoms and that are strongly affected (and perhaps caused by) stress.

The mechanisms behind IBS are not completely understood and it is likely that it is multiple things that come together to contribute to symptoms in an individual manner. Read on to understand each proposed mechanism that contributes to IBS symptoms.

There will be a lot of information in this lesson! After reading about the IBS mechanisms, you will also have a better understanding on the interconnectedness of the mechanisms. And what is highly interesting, is that stress can cause them all – no wonder I’m devoting so much space here on stress management!

In the next lesson I will discuss gut disorders that have similar symptoms with IBS. This is an important topic, as we want to make sure that what we have is not one of them!

  1. Dimidi et al. Mechanisms of Action of Probiotics and the Gastrointestinal Microbiota on Gut Motility and Constipation. Adv Nutr. 2017 May; 8(3): 484–494. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5421123/
  2. Zhou, Q., and Verne, N. New insights into visceral hypersensitivity —clinical implications in IBS. Nat Rev Gastroenterol Hepatol. 2011 June ; 8(6): 349–355. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437337/pdf/nihms395614.pdf
  3. Answari, P. Acute Abdominal Pain. Revised 04/2023 https://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/acute-abdominal-pain
  4. Spiller, R. Impact of diet on IBS symptoms. Nutrients. 2021 Feb; 13(2): 575. https://www.ncbi.nlm.nih.gov/pmc/articleas/PMC7915127/
  5. Shea-Donohue, T. et al. Mast Cells. Curr Gastroenterol Rep. 2010 October ; 12(5): 349–357. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693738/pdf/nihms233210.pdf 
  6. Pedersen, M. Chronic Fatigue Syndrome and chronic pain conditions – protective systems gone wrong. Scandinavian Journal of Pain. 2019. Vol 19. Issue 4.
  7. McAllister, M. What is central desensitization? Institute of chronic pain. 2013, updated 2017. https://www.instituteforchronicpain.org/understanding-chronic-pain/what-is-chronic-pain/central-sensitization 
  8. Khoshbin K, and Camilleri, M. Effects of dietary components on intestinal permeability in health and disease. Am J Physiol Gastrointest Liver Physiol. 2020 Nov 1; 319(5): G589–G608. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087346/
  9. Fasano, A. All disease begins in the (leaky) gut: role of zonulin-mediated gut permeability in the pathogenesis of some chronic inflammatory disease. Version 1. F1000Res. 2020; 9: F1000 Faculty Rev-69. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6996528/
  10. Calzadilla, M et al. Bile acids as inflammatory mediators and modulators of intestinal permeability. Front Immunol. 2022 Dec 7:13:1021924. https://pubmed.ncbi.nlm.nih.gov/36569849/
  11. Zhou, Q. et al. A Randomized Placebo-Controlled Trial of Dietary Glutamine Supplements for Post-Infectious Irritable Bowel Syndrome. Gut. 2019 Jun; 68(6): 996–1002. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9549483/
  12. Bellini, M et al. Use of GELSECTAN® in Patients with Irritable Bowel Syndrome (IBS): an Italian Experience. https://doi.org/10.2147/PPA.S318859
  13. Trifan et al. Efficacy and safety of Gelsectan for diarrhoea-predominant irritable bowel syndrome: A randomised, crossover clinical trial. ted European Gastroenterol J. 2019 Oct;7(8):1093-1101. https://pubmed.ncbi.nlm.nih.gov/31662866/
  14. Asociación Española de Gastroenterologí (2019) Documento de actualización de la Guía de Práctica Clínicasobre el síndrome del intestino irritable. (p. 55) https://www.aegastro.es/sites/default/files/archivos/guia-clinica/siendrome_del_intestino_irritable.pdf
  15. Neri M. La sindrome del colon irritabile. Rivista Società Italiana di Medicina Generale. 2019; 26(4):46-48.
  16. Campos-Rodriguez, R., Godinez-Victoria, M., Abarca-Rojano, E., Pacheco-Yepez, J., Reyna-Garfias, H., Barbosa-Cabrera, R. E., & Drago-Serrano, M. E. (2013). Stress Modulates Intestinal Secretory Immunoglobulin A. Frontiers in Integrative Neuroscience, 7, 86. 
  17. Michels, N., Van De Wiele, T., Fouhy, F., O’Mahony, S., Clarke, G., & Keane, J. (2019). Gut Microbiome Patterns Depending on Children’s Psychosocial Stress: Reports Versus Biomarkers. Brain, Behavior, and Immunity, 80, 751–762. 
  18. Rodriguez-Daza, M. C. and de Vos, W. M. Polyphenols as Drivers of a Homeostatic Gut Microecology and Immuno-Metabolic Traits of Akkermansia muciniphila: From Mouse to Man. Int J Mol Sci. 2023 Jan; 24(1): 45. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9820369/
  19. Mayer E. A., et al. The Gut Brain Axis. Annual review of medicine. Vol. 73:439-453. 2022.
  20. Drossman, D. A. (2016). Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology, 150, 1262–1279.e2. 
  21. Hong, S. N. and Rhee P-L. Unraveling the ties between irritable bowel syndrome and intestinal microbiota. World J Gastroenterol. 2014 Mar 14; 20(10): 2470–2481.
  22. El-Salhy et al. Fecal microbiota transplantation for irritable bowel syndrome: An intervention for the 21st century. World J Gastroenterol. 2021 Jun 14; 27(22): 2921–2943.
  23. Ng, Q. X. et al. The role of inflammation in irritable bowel syndrome (IBS). J Inflamm Res. 2018; 11: 345–349.
  24. Koloski, N et al. Population based study: atopy and autoimmune diseases are associated with functional dyspepsia and irritable bowel syndrome, independent of psychological distress. Alimentary Pharmacology and Therapeutics. Volume 49, Issue.5March 2019. Pages 546-555
  25. Vivinius-Nebot, M. et al. Combination of Allergic Factors Can Worsen Diarrheic Irritable Bowel Syndrome: Role of Barrier Defects and Mast Cells. American Journal of Gastroenterology 107(1):p 75-81, January 2012.
  26. Spiller, R. Impact of Diet on Symptoms of the Irritable Bowel Syndrome. Nutrients 2021, 13, 575. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915127/pdf/nutrients-13-00575.pdf
  27. Ng, Q. X. et al. Systematic review with meta-analysis: The association between post-traumatic stress disorder and irritable bowel syndrome. Gastroenterology and hepatology. Volume34, Issue1 January 2019 Pages 68-73
  28. Henström M. and D’Amato, M. Genetics of irritable bowel syndrome. Mol Cell Pediatr. 2016 Dec; 3: 7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4752571/
  29. Canavan C, West J, Card T. The epidemiology of irritable bowel syndrome. Clinical Epidemiology 2014;6:71-80. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3921083/
  30. Eijsbouts, C., Zheng, T., Kennedy, N.A. et al. Genome-wide analysis of 53,400 people with irritable bowel syndrome highlights shared genetic pathways with mood and anxiety disorders. Nat Genet 53, 1543–1552 (2021). https://doi.org/10.1038/s41588-021-00950-8
  31. Freepik.com. Image by brgfx.
  32. Konstantis G, Efstathiou S, Pourzitaki C, Kitsikidou E, Germanidis G, Chourdakis M. Efficacy and safety of probiotics in the treatment of irritable bowel syndrome: A systematic review and meta-analysis of randomised clinical trials using ROME IV criteria. Clin Nutr. 2023 May;42(5):800-809. doi: 10.1016/j.clnu.2023.03.019. Epub 2023 Mar 31. PMID: 37031468
  33. Mayer EA, Labus JS, Tillisch K, Cole SW, Baldi P. Towards a systems view of IBS. Nat Rev Gastroenterol Hepatol. 2015 Oct;12(10):592-605. doi: 10.1038/nrgastro.2015.121. Epub 2015 Aug 25. PMID: 26303675; PMCID: PMC5001844.
  34. Lupu VV, Ghiciuc CM, Stefanescu G, Mihai CM, Popp A, Sasaran MO, Bozomitu L, Starcea IM, Adam Raileanu A, Lupu A. Emerging role of the gut microbiome in post-infectious irritable bowel syndrome: A literature review. World J Gastroenterol. 2023 Jun 7;29(21):3241-3256. doi: 10.3748/wjg.v29.i21.3241. PMID: 37377581; PMCID: PMC10292139.
  35. Mamieva Z, Poluektova E, Svistushkin V, Sobolev V, Shifrin O, Guarner F, Ivashkin V. Antibiotics, gut microbiota, and irritable bowel syndrome: What are the relations? World J Gastroenterol. 2022 Mar 28;28(12):1204-1219. doi: 10.3748/wjg.v28.i12.1204. PMID: 35431513; PMCID: PMC8968486.