Irritable bowel syndrome – risk factors and the role of antispasmodic drugs. The point of view of a gastroenterologist and psychologist Review article

Abstract

Irritable bowel syndrome (IBS) is a highly prevalent, chronic disorder that significantly reduces patients’ quality of life. In clinical practice, IBS is characterized by symptoms of recurrent ab-dominal pain and disordered defecation. Rome IV criteria, derived by consensus from a multi-national group of experts, can be used to diagnose IBS. The pathophysiology of IBS is multi-factorial in nature, and it is thought to include contributions from factors such as gut microbiota dysbiosis, altered intestinal and colonic permeability, GI immune cell activation, visceral hyper-sensitivity, and abnormal gut-brain interactions. The first line therapeutic approach is directed towards education, reassurance and lifestyle modification. In case of an unsatisfactory response, an appropriate pharmacologic therapy can be suggested on the basis of digestive symptoms and/or psychological disturbances. Antispasmodic agents reduce the abdominal pain associated with IBS by inhibiting the postprandial contractility pathways in the gut wall and improve bow-el habits by increasing the colonic transit time, which reduces the frequency of stool passage, particularly in diarrhea-dominant IBS.