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Irritable bowel syndrome, a widespread gastrointestinal discomfort

What is IBS?
IBS, or irritable bowel syndrome, is a gastrointestinal discomfort that affects a large number of individuals. Deepening our understanding of this condition is crucial, considering its complexity and its impact on patients’ daily lives.

IBS represents a chronic functional disorder of the intestine and is characterised by disturbances in intestinal motility, altered stool consistency and pain perception, without obvious signs of physical damage to the intestine. This condition, with a chronic and unpredictable nature, can significantly impair patients’ quality of life.

Epidemiology:

It is estimated that IBS affects 10-15% of the world’s population, with a higher prevalence in women than men, and despite its widespread incidence, IBS remains a poorly understood and often underestimated condition. Age is also an important risk factor for this condition, with the 20-35 age group being the most affected.
Other important risk factors are stress, an unbalanced diet, often low in fibre and thus in fruit and vegetables, intestinal infections and genetic predisposition.

Main Symptoms:

Symptoms vary widely among patients and include abdominal pain, bloating, changes in frequency of evacuations and stool consistency. The complexity of these symptoms makes a personalised approach to managing IBS crucial. Moreover, the generality of symptoms often slows down the correct diagnosis of the condition, thus lengthening the time to implement the correct treatment strategy.

Subtypes and Classifications:

IBS can be subdivided into subtypes based on predominant symptoms, including IBS with constipation/ constipation, IBS with diarrhoea, mixed IBS (with diarrhoea and constipation) and unclassifiable IBS, in which no clear subtype can be identified.

These distinctions are essential to tailor the treatment to the specific needs of each patient. Moreover, they are not fixed and immutable over time, in fact some patients may manifest different subtypes within a few weeks.

This great variability is due to the alterations in the gut, and the existing connections between the gut and the brain of the affected patients. This two-way communication is becoming increasingly important in the context of gastrointestinal diseases, but also in the normal physiology of the human organism, demonstrating how these two organs can influence each other.

Rome IV criteria:

The most recent diagnostic criteria for IBS, known as Rome IV, require the presence of abdominal pain at least once a week during the preceding three months, associated with two or more of the following criteria: a) associated with defecation, b) changes in the frequency of evacuations and c) changes in stool consistency.

The Rome IV criteria allow IBS to be sub-classified into IBS with constipation, diarrhoea, mixed or unclassifiable.

Pathogenic causes:

The precise causes of IBS remain elusive, but research suggests the presence of some common factors in the onset and maintenance of this condition:

1)An altered intestinal permeability, due to an alteration in the structures that hold the cells of the intestinal wall together. This favours the passage of toxins, molecules and bacteria into the circulation that support the inflammation typical of this condition.

2)Altered activity of the immune system: this increased activity maintains the inflammation contributing to the development of symptoms typical of IBS

3)Altered visceral sensitivity: this characteristic leads to increased perception of pain and increased sensitivity to stimuli by the intestines of these patients

4)Intestinal dysbiosis: by dysbiosis we refer to the presence, at intestinal level, of an altered bacterial flora that is not very beneficial for our intestines and the body in general. The set of microorganisms that populate our gut is called the ‘intestinal microbiota’ and is fundamental to the health of our body. In patients with IBS, the presence of altered bacterial flora characterised by pro-inflammatory bacteria is common.

All these factors are interconnected, self-feeding and self-sustaining causing the symptoms and overall picture of IBS. It is also not easy to understand whether there is an order in the onset of these alterations or whether they occur in conjunction with each other.

Of considerable importance for IBS is also the psychological sphere. It has been noted that many of the patients with IBS are also particularly anxious people and that excessive stress can occur concomitantly with IBS symptoms. This is a point of reflection that emphasises the importance of the emotions and psyche of IBS patients.

La Sfida della Comprensione:

IBS, despite its widespread occurrence, is still the subject of many questions. Lack of public awareness and limited understanding of the condition often lead to an underestimation of its effects and delay a timely diagnosis.

In conclusion, IBS represents an intricate medical maze, with the Rome IV criteria providing guidance in its diagnosis. Addressing this condition requires a concerted effort in awareness, research and personalisation of treatments to improve the quality of life of those affected.

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