Irritable bowel syndrome: a multidimensional review of pathophysiology, biomarkers, and tailored interventions
DOI:
https://doi.org/10.18203/2320-6012.ijrms20254402Keywords:
Irritable bowel syndrome, Rome IV criteria, Gut-brain axis, Visceral hypersensitivity, Microbiota, Neurotransmitters, Overlap syndromes, BiomarkersAbstract
Irritable bowel syndrome is a chronic, functional gastrointestinal disorder characterized by recurrent abdominal pain and altered bowel habits without identifiable structural or biochemical abnormalities. It significantly impairs quality of life and remains a diagnostic and therapeutic challenge due to its multifactorial pathophysiology and symptom heterogeneity. This review synthesizes evolving evidence on the epidemiology, Rome-IV diagnostic criteria, and pathophysiological mechanisms including visceral hypersensitivity, gut-brain axis dysregulation, microbiota alterations, immune activation, and genetic factors. Special focus is placed on the neurobiology of IBS, highlighting structural and functional brain network changes, neurotransmitter involvement, and microbiota-gut-brain interactions. The manuscript also covers the overlap of IBS with other gastrointestinal and extra intestinal disorders, biomarker innovations, and the clinical value of positive diagnosis over exclusionary practices. A comprehensive, symptom-guided management strategy encompassing pharmacologic therapies, microbial modulation, dietary interventions, and psychological approaches is discussed. A structured approach to IBS begins with a confident diagnosis, followed by identification of underlying mechanisms through symptom assessment and pragmatic testing, and tailored treatment- such as probiotics (e.g. Bifidobacterium) for dysbiosis or antispasmodics (e.g. Mebeverine) for motility and pain, while tracking progress and adjusting therapy toward realistic symptom control goals. This integrative model underscores the necessity of personalized treatment to improve outcomes and patient satisfaction.
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