PHILADELPHIA – The pathophysiology of irritable bowel syndrome (IBS) was the focus of a presentation given by Dr. Anthony J. Lembo at the 2nd annual Digestive Diseases meeting in Philadelphia on Friday.
Specifically, Dr. Lembo discussed the debate about whether diagnosing the condition should focus on a patient’s gut or head; that is, if enhanced perception of a bowel disorder can lead to visceral hypersensitivity and altered motility, which results in a diagnosis of IBS when, in fact, the issue is psychosomatic. Dr. Lembo, a professor at Harvard Medical School and Beth Israel Deaconess Medical Center, explained that there is a growing shift toward diagnosing IBS as a brain-to-gut interaction rather than as something based purely on limited motility. Patients presenting with comorbid conditions such as depression, migraine, anxiety, neuralgia, chronic fatigue or pain, or fibromytosis are all more likely to not only have IBS, but to have more severe symptoms and lower quality of life.
“When I see a patient who has a lot of these symptoms together, I realize that I need to be very aggressive and use a multimodal approach,” said Dr. Lembo. “I talk to their other physicians, and do more of the brain treatment, psychological treatment, CNS drugs, as well as some peripheral ones.”
For these reasons, Dr. Lembo said that the current Rome III criteria for treatment of IBS are not sufficient to be used on their own in diagnosing and treating IBS, saying “IBS is a heterogeneous disorder with both peripheral and central mechanisms” that must be treated as such. In treating the central nervous system, Dr. Lembo discussed 5-HT3 antagonists, serotonin modulators, antidepressants, and placebos. Peripheral treatments can come in the form of either diets, fiber regimens, antibiotics, GC-C agonists*, 5-HT3 antagonists, and probiotics/prebiotics, although efficacies and approvals vary.
Dr. Lembo disclosed numerous potential conflicts of interest: consultantships with Ironwood/Forest, Astra-Zeneca, Furiex, Salix, Prometheus, Astellas, and GlaxoSmithKlinel; honoraria from Ironwood/Forest, Astra-Zeneca, Furiex, Salix, Prometheus, and GlaxoSmithKline; and research grants/contracts from Prometheus and Furiex.
*Content was corrected on 7/1/2015.