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The role of inflammation in irritable bowel syndrome (IBS)
Authors Ng QX, Soh AYS, Loke W, Lim DY, Yeo WS
Received 22 May 2018
Accepted for publication 26 July 2018
Published 21 September 2018 Volume 2018:11 Pages 345—349
DOI https://doi.org/10.2147/JIR.S174982
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 3
Editor who approved publication: Dr Ning Quan
Qin Xiang Ng,1,2 Alex Yu Sen Soh,1 Wayren Loke,2 Donovan Yutong Lim,3 Wee-Song Yeo1
1National University Hospital, National University Health System, Singapore; 2MOH Holdings Pte Ltd, Singapore; 3Institute of Mental Health, Singapore
Abstract: Irritable bowel syndrome (IBS) is a complex, functional gastrointestinal disorder characterized by chronic abdominal pain or discomfort and altered bowel habits. Despite the global prevalence and disease burden of IBS, its underlying pathophysiology remains unclear. Inflammation may play a pathogenic role in IBS. Studies have highlighted the persistence of mucosal inflammation at the microscopic and molecular level in IBS, with increased recruitment of enteroendocrine cells. Substantial overlaps between IBS and inflammatory bowel disease have also been reported. This review thus aimed to discuss the body of evidence pertaining to the presence of mucosal inflammation in IBS, its putative role in the disease process of IBS, and its clinical relevance. Increased mast cell density and activity in the gut may correlate with symptoms of visceral hypersensitivity. As evidenced by patients who develop postinfectious IBS, infective gastroenteritis could cause systemic inflammation and altered microbiome diversity, which in turn perpetuates a cycle of chronic, low-grade, subclinical inflammation. Apart from mucosal inflammation, neuroinflammation is probably involved in the pathophysiology of IBS via the “gut–brain” axis, resulting in altered neuroendocrine pathways and glucocorticoid receptor genes. This gives rise to an overall proinflammatory phenotype and dysregulated hypothalamic–pituitary–adrenal axis and serotonergic (5-HT) functioning, which could, at least in part, account for the symptoms of IBS. Although a definite and reproducible pattern of immune response has yet to be recognized, further research into anti-inflammatories may be of clinical value.
Keywords: irritable bowel syndrome, postinfectious, inflammation, microbiome
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