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New Insights into Irritable Bowel Syndrome
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New Insights into Irritable Bowel Syndrome

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (26 April 2025) | Viewed by 9827

Special Issue Editors

Dr. Pierfrancesco Visaggi

E-Mail Website
Guest Editor
Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
Interests: disorders of gut-brain interaction; irritable bowel syndrome; eosinophilic gastrointestinal disorders; diarrhoea; abdominal pain; high-resolution manometry
Prof. Dr. Massimo Bellini

E-Mail Website
Guest Editor
Gastrointestinal Unit, Department of Translational Sciences and New Technology in Medicine and Surgery, University of Pisa, 56124 Pisa, Italy
Interests: disorders of gut–brain interaction; irritable bowel syndrome; FODMAPs; low-FODMAP diet; anorectal manometry; chronic constipation; functiona dyspepsia; gastroparesis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear colleagues,

Irritable bowel syndrome (IBS) is a highly prevalent gastrointestinal disease that represents a significant cause of morbidity worldwide. The disease significantly affects patients’ quality of life, work productivity and social functioning. The pathophysiology of IBS is not completely understood and its diagnosis should be made based on the Rome IV criteria. Nevertheless, the severity of the patient’s symptoms and concerns sometimes drives the physician to perform useless and/or expensive diagnostic tests, transforming IBS into a diagnosis of exclusion. Therefore, a deeper knowledge of IBS mechanisms is mandatory to improve the management of the disease. Conventional treatments include lifestyle changes, diets, probiotics, laxatives, antidiarrhoeals and antispasmodics. More recently, other therapies have been investigated in randomized controlled trials and observational studies, including faecal microbiota transplantation, central neuromodulators, intestinal secretagogues, drugs acting on opioid or 5-HT receptors, minimally absorbed antibiotics, and psychological therapies.

The scientific community will certainly benefit from updated reviews focusing on the optimal management of IBS. In this Special Issue, we invite you to submit your updated review addressing the management aspects and/or therapeutics of IBS.

We look forward to your contribution relating to this cutting-edge Special Issue of the Journal of Clinical Medicine.

Dr. Pierfrancesco Visaggi
Prof. Dr. Massimo Bellini
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • irritable bowel syndrome
  • management
  • disorders of gut–brain interactions
  • neuromodulators
  • fecal microbiota
  • probiotics
  • diet
  • FODMAPs
  • intestinal secretagogues
  • 5-HT receptors

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Published Papers (5 papers)

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Research

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19 pages, 967 KiB  
Article
Depression in Diarrhea-Predominant IBS Patients: Exploring the Link Between Gut Barrier Dysfunction and Erythrocyte Polyunsaturated Fatty Acid Levels
by Michele Linsalata, Laura Prospero, Antonia Ignazzi, Giuseppe Riezzo, Benedetta D’Attoma, Domenica Mallardi, Francesco Goscilo, Maria Notarnicola, Valentina De Nunzio, Giuliano Pinto and Francesco Russo
J. Clin. Med. 2025, 14(7), 2483; https://doi.org/10.3390/jcm14072483 - 5 Apr 2025
Viewed by 275
Abstract
Background: Patients with irritable bowel syndrome (IBS) often experience comorbid psychological conditions, notably depression and anxiety. Evidence suggests that these conditions are linked to gut barrier dysfunction, dysbiosis, and chronic inflammation. All these factors are central to IBS pathophysiology and mood disturbances. [...] Read more.
Background: Patients with irritable bowel syndrome (IBS) often experience comorbid psychological conditions, notably depression and anxiety. Evidence suggests that these conditions are linked to gut barrier dysfunction, dysbiosis, and chronic inflammation. All these factors are central to IBS pathophysiology and mood disturbances. Polyunsaturated fatty acids (PUFAs) play crucial roles in modulating inflammation and depression. This study examined the associations among intestinal permeability, PUFA profiles, low-grade inflammation, and depression severity in IBS patients with diarrhea (IBS-D). Methods: Forty-three IBS-D patients (7 men, 36 women; 44.56 ± 1.52 years) were categorized into depressed (IBS-D(d+)) and non-depressed (IBS-D(d−)) groups according to scores on the depression subscale of the Symptom Checklist-90-Revised (SCL-90-R). Biomarkers of small intestinal permeability (s-IP) were assessed in urine and blood, alongside erythrocyte membrane PUFA composition, dysbiosis, and inflammation indices. Results: IBS-D (d+) patients exhibited elevated s-IP and altered PUFA metabolism compared to their IBS-D (d−) counterparts. Additionally, in the first group, omega-3 PUFA concentrations inversely correlated with s-IP biomarkers, while the omega-6/omega-3 ratio showed a positive correlation. Moreover, depression severity is significantly associated with s-IP markers and omega-3 PUFA levels. Lastly, IBS-D (d+) patients exhibited higher levels of dysbiosis and pro-inflammatory cytokines than IBS-D (d−) patients. Conclusions: These findings highlight the interplay between intestinal barrier integrity and PUFA metabolism in IBS-D patients with depression, suggesting that s-IP markers and erythrocyte PUFA profiles could represent novel therapeutic targets for managing depression in this population. This study was registered on ClinicalTrials.gov (NCT03423069), with a date of registration of 30 January 2018. Full article
(This article belongs to the Special Issue New Insights into Irritable Bowel Syndrome)
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18 pages, 2628 KiB  
Article
Efficacy and Safety of a Mixture of Microencapsulated Sodium Butyrate, Probiotics, and Short Chain Fructooligosaccharides in Patients with Irritable Bowel Syndrome—A Randomized, Double-Blind, Placebo-Controlled Study
by Anita Gąsiorowska, Marek Romanowski, Ewa Walecka-Kapica, Aleksandra Kaczka, Cezary Chojnacki, Milena Padysz, Marta Siedlecka, Julia Banasik, Aleksandra Sobolewska-Włodarczyk, Maria Wiśniewska-Jarosińska, Joanna B. Bierła, Nize Otaru, Bożena Cukrowska and Robert E. Steinert
J. Clin. Med. 2025, 14(1), 6; https://doi.org/10.3390/jcm14010006 - 24 Dec 2024
Viewed by 1287
Abstract
Objective: Biotics are increasingly being used in the treatment of irritable bowel syndrome (IBS). This study aimed to assess the efficacy and safety of a mixture of microencapsulated sodium butyrate, probiotics (Lactocaseibacillus rhamnosus DSM 26357, Lactobacillus acidophilus DSM 32418, Bifidobacterium longum DSM [...] Read more.
Objective: Biotics are increasingly being used in the treatment of irritable bowel syndrome (IBS). This study aimed to assess the efficacy and safety of a mixture of microencapsulated sodium butyrate, probiotics (Lactocaseibacillus rhamnosus DSM 26357, Lactobacillus acidophilus DSM 32418, Bifidobacterium longum DSM 32946, Bifidobacterium bifidum DSM 32403, and Bifidobacterium lactis DSM 32269), and short-chain fructooligosaccharides (scFOSs) in IBS patients. Methods: This was a randomized, double-blind, placebo-controlled trial involving 120 adult participants with IBS. The primary outcome of the 12-week intervention was the improvement in IBS symptoms and quality of life (QOL), assessed with the use of IBS-Adequate Relief (IBS-AR), IBS-Global Improvement Scale (IBS-GIS), IBS-Symptom Severity Score (IBS-SSS), and IBS-QOL. Secondary outcomes were the number and type of stools (assessed via the Bristol Stool Form scale), patient-recorded symptoms, anthropometric parameters, and levels of selected inflammatory cytokines. Results: As early as at 4 weeks, there was a higher percentage of patients in the biotic group reporting adequate relief of symptoms (based on IBS-AR) than in the placebo group (64.7% vs. 42.0%, respectively, p = 0.023). At 12 weeks, fewer patients in the biotic group reported a ‘worsening of symptoms’ (based on IBS-GIS) than in the placebo group (5.9% vs. 16.0% respectively, p = 0.015). There were no significant differences between groups in IBS-QOL or IBS-SSS or any of the secondary outcome measures except the patient-recorded ‘urgency to defecate’ (p = 0.015) at week 12, which was significantly lower in the biotic group. The intervention was safe and well tolerated. Conclusions: A biotic mixture consisting of microencapsulated butyrate, probiotics, and small amounts of scFOSs is safe and effective in improving gastrointestinal symptoms in patients with IBS. Full article
(This article belongs to the Special Issue New Insights into Irritable Bowel Syndrome)
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Review

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19 pages, 767 KiB  
Review
Functional Foods and Nutraceuticals in Irritable Bowel Syndrome
by Giovanni Marasco, Cesare Cremon, Daniele Salvi, David Meacci, Elton Dajti, Luigi Colecchia, Maria Raffaella Barbaro, Vincenzo Stanghellini and Giovanni Barbara
J. Clin. Med. 2025, 14(6), 1830; https://doi.org/10.3390/jcm14061830 - 8 Mar 2025
Viewed by 1154
Abstract
Irritable bowel syndrome (IBS) is a common disorder of gut–brain interaction, with a multifactorial pathophysiology involving gut–brain axis dysregulation, visceral hypersensitivity, microbiota imbalance, and immune dysfunction. Traditional IBS management emphasizes dietary modifications and pharmacologic therapies. However, increasing attention has been directed toward functional [...] Read more.
Irritable bowel syndrome (IBS) is a common disorder of gut–brain interaction, with a multifactorial pathophysiology involving gut–brain axis dysregulation, visceral hypersensitivity, microbiota imbalance, and immune dysfunction. Traditional IBS management emphasizes dietary modifications and pharmacologic therapies. However, increasing attention has been directed toward functional foods, nutraceuticals, and herbal remedies due to their potential to target IBS pathophysiological mechanisms with favorable safety profiles. This clinical review explores the role of these adjunctive therapies, evaluating evidence from preclinical and clinical studies. Functional foods such as kiwifruit, prunes, and rye bread demonstrate benefits in bowel habit regulation through fiber content and microbiota modulation. Nutraceuticals like peppermint oil, palmitoylethanolamide, and herbal mixtures exhibit anti-inflammatory, antispasmodic, and analgesic effects. Prebiotics provide substrate-driven microbiota changes, although dosage is key, as given their fermentative properties, when used at high dosages, they can exacerbate symptoms in some individuals. Probiotics and postbiotics offer microbiota-based interventions with promising symptom relief in IBS subtypes, although factors for personalized treatment still need to be further elucidated. These strategies highlight a paradigm shift in IBS management, integrating diet-based therapies with evolving nutraceutical options to improve patient outcomes. Despite promising findings, challenges in standardizing definitions, mechanisms, and safety profiles still remain. Rigorous, large-scale trials to validate the therapeutic potential of these interventions are needed, to enhance the benefits of these compounds with an individualized treatment approach. Full article
(This article belongs to the Special Issue New Insights into Irritable Bowel Syndrome)
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17 pages, 457 KiB  
Review
A Review of Pharmacologic and Non-Pharmacologic Therapies in the Management of Irritable Bowel Syndrome: Current Recommendations and Evidence
by Anthony J. Papale, Robert Flattau, Nandan Vithlani, Deepti Mahajan and Sandeep Nadella
J. Clin. Med. 2024, 13(22), 6948; https://doi.org/10.3390/jcm13226948 - 18 Nov 2024
Cited by 2 | Viewed by 3456
Abstract
Irritable bowel syndrome (IBS) is a highly prevalent and debilitating disorder of gut–brain interaction (DGBI) affecting millions globally. It imposes a significant burden on healthcare systems and is a leading cause of workplace absenteeism. IBS is classified into several subtypes based on predominant [...] Read more.
Irritable bowel syndrome (IBS) is a highly prevalent and debilitating disorder of gut–brain interaction (DGBI) affecting millions globally. It imposes a significant burden on healthcare systems and is a leading cause of workplace absenteeism. IBS is classified into several subtypes based on predominant presenting symptoms, including IBS with constipation (IBS-C) and IBS with diarrhea (IBS-D), with each requiring targeted approaches to treatment. Some treatments, such as psychotherapy, dietary intervention, and medications like tricyclic antidepressants, are nonspecific and recommended for managing IBS symptoms across all subtypes. In contrast, therapies like secretagogues for IBS-C and eluxadoline or rifaximin for IBS-D are subtype-specific. However, many IBS treatments carry conditional recommendations and are based on low-certainty evidence, emphasizing the need for further research to expand the available treatment options. This review compares the latest IBS management guidelines from the American Gastroenterological Association (AGA), American College of Gastroenterology (ACG), British Society of Gastroenterology (BSG), and European Society for Neurogastroenterology and Motility (ESNM). Pharmacologic and non-pharmacologic therapies, including established and emerging interventions, will be explored to provide a comprehensive guide to management. Full article
(This article belongs to the Special Issue New Insights into Irritable Bowel Syndrome)
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17 pages, 1038 KiB  
Review
The Latest Data Concerning the Etiology and Pathogenesis of Irritable Bowel Syndrome
by Vlad Alexandru Ionescu, Gina Gheorghe, Teodor Florin Georgescu, Nicolae Bacalbasa, Florentina Gheorghe and Camelia Cristina Diaconu
J. Clin. Med. 2024, 13(17), 5124; https://doi.org/10.3390/jcm13175124 - 29 Aug 2024
Cited by 5 | Viewed by 3048
Abstract
Globally, irritable bowel syndrome (IBS) is present in approximately 10% of the population. While this condition does not pose a risk of complications, it has a substantial impact on the patient’s quality of life. Moreover, this disease has a significant financial impact on [...] Read more.
Globally, irritable bowel syndrome (IBS) is present in approximately 10% of the population. While this condition does not pose a risk of complications, it has a substantial impact on the patient’s quality of life. Moreover, this disease has a significant financial impact on healthcare systems. This includes the direct costs associated with the diagnosis and treatment of these patients, as well as the indirect costs that arise from work absenteeism and reduced productivity. In light of these data, recent research has focused on elucidating the pathophysiological basis of this condition in order to improve the quality of life for affected individuals. Despite extensive research to date, we still do not fully understand the precise mechanisms underlying IBS. Numerous studies have demonstrated the involvement of the gut–brain axis, visceral hypersensitivity, gastrointestinal dysmotility, gut microbiota dysbiosis, food allergies and intolerances, low-grade mucosal inflammation, genetic factors, and psychosocial factors. The acquisition of new data is crucial for the advancement of optimal therapeutic approaches aimed at enhancing the general health of these patients while simultaneously reducing the financial burden associated with this ailment. Full article
(This article belongs to the Special Issue New Insights into Irritable Bowel Syndrome)
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