New perspectives in irritable bowel syndrome:

Article Outline

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Symptoms of the irritable bowel syndrome (IBS) occur in the absence of underlying structural or biochemical abnormalities within or outside the gut. Although widely accepted, this definition reflects uncertainty on the actual nature of the symptoms and does not satisfy patients. Nonetheless, the future is likely to be brighter since research in the field of IBS is fast moving and cellular, molecular and microbiological mechanisms are being identified and recognised as significant players in the complex pathophysiology of IBS. These recent steps forward in the understanding of IBS pathophysiology represent a unique opportunity to speed up the process of drug development and help manage one of the most common disorders of the humankind.

This is an exciting issue of Digestive and Liver Disease for both the clinical and research oriented readership. The issue includes three state-of-the art review articles as the second part of a mini symposium, written by world's top authorities on the most advanced aspects and views on the pathophysiology and treatment of IBS. The first review manuscript by Robin Spiller and Klara Garsed addresses the issue of acute gastroenteritis as a distinctive aetiological factor, accounting for 6–17% of all IBS patients. In their review, the authors examine risk factors for development of IBS after gastroenteritis as well as the role of low grade mucosal immune activation, which is detectable in a large proportion of these patients, but also in patients with nonspecific IBS. Low grade immune activation may act by increasing epithelial permeability, and affecting sensory and enteric nerve function hence evoking gut dysfunction and symptom perception. In the second review article Collins et al. describe the emerging concept that intestinal microbiota interacts in a bidirectional fashion with gut functions in IBS. Interestingly, data obtained in animal models suggest that changes in gut flora may also influence behaviour providing a basis for a novel provocative hypothesis linking changes in gut microbiota with psychological comorbidity seen in IBS patients. The last review article by Michael Camilleri and Viola Andresen provides a unique perspective on current and novel therapeutic strategies for IBS management. The authors review the role of many compounds, commercialised or under investigation, acting on serotonin receptor and transporter systems, antidepressants, novel selective anticholinergics, opioid agents, cholecystokinin-antagonists, neurokinin-antagonists, somatostatin receptor agonists, corticotropin releasing factor antagonists, chloride-channel activators, guanylate-cyclase-c agonists, melatonin, atypical benzodiazepines, antibiotics, immune modulators and probiotics.

We are very grateful to the authors for having accepted our invitation to write these brilliant reviews, and for providing the readers of Digestive and Liver Disease with unique, up-to-date and provocative views on current and future perspectives in IBS research.

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Conflict of interest statement 

None declared.