Key studies published in 2022 further established the importance of alterations in the gut microenvironment and interactions with the enteric and central nervous systems in symptom generation in irritable bowel syndrome and suggested novel and clinically accessible therapeutic approaches for this large group of patients.
Key advances
-
Histamine, a known neuroimmune modulator, is produced by gut bacteria and can induce abdominal pain; therefore, bacterial histamine is an attractive therapeutic target for treating abdominal pain in irritable bowel syndrome (IBS)6.
-
Dietary advice using a FODMAP-lowering smartphone application was superior to a spasmolytic agent in primary care IBS, demonstrating its usefulness as a first-line treatment option for IBS in primary care9.
-
The intestinal adsorbent enterosgel (polymethylsiloxane polyhydrate), which is a readily available over-the-counter product, improved abdominal pain and diarrhoeal symptoms in patients with IBS with diarrhoea in a large double-blinded placebo-controlled 8-week clinical trial10.
This is a preview of subscription content, access via your institution
Access options
Access Nature and 54 other Nature Portfolio journals
Get Nature+, our best-value online-access subscription
$29.99 / 30 days
cancel any time
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Simrén, M. & Tack, J. New treatments and therapeutic targets for IBS and other functional bowel disorders. Nat. Rev. Gastroenterol. Hepatol. 15, 589–605 (2018).
Shanahan, F. & Quigley, E. M. M. Manipulation of the microbiota for treatment of IBS and IBD — challenges and controversies. Gastroenterology 146, 1554–1563 (2014).
Mars, R. A. T. et al. Longitudinal multi-omics reveals subset-specific mechanisms underlying irritable bowel syndrome. Cell 183, 1137–1140 (2020).
Mujagic, Z. et al. Integrated fecal microbiome–metabolome signatures reflect stress and serotonin metabolism in irritable bowel syndrome. Gut Microbes 14, 2063016 (2022).
McIntosh, K. et al. FODMAPs alter symptoms and the metabolome of patients with IBS: a randomised controlled trial. Gut 66, 1241–1251 (2017).
De Palma, G. et al. Histamine production by the gut microbiota induces visceral hyperalgesia through histamine 4 receptor signaling in mice. Sci. Transl Med. 14, eabj1895 (2022).
Barbara, G. et al. Mast cell-dependent excitation of visceral-nociceptive sensory neurons in irritable bowel syndrome. Gastroenterology 132, 26–37 (2007).
Deiteren, A. et al. Histamine H4 and H1 receptors contribute to postinflammatory visceral hypersensitivity. Gut 63, 1873–1882 (2014).
Carbone, F. et al. Diet or medication in primary care patients with IBS: the DOMINO study - a randomised trial supported by the Belgian Health Care Knowledge Centre (KCE Trials Programme) and the Rome Foundation Research Institute. Gut 71, 2226–2232 (2022).
Howell, C. A. et al. Double-blinded randomised placebo controlled trial of enterosgel (polymethylsiloxane polyhydrate) for the treatment of IBS with diarrhoea (IBS-D). Gut 71, 2430–2438 (2022).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
M.S. declares research funding (paid to institution) from Glycom/DSM; advisory and/or consultancy for Danone Nutricia Research, Ironwood, Menarini, Biocodex, Genetic Analysis AS, DSM, Tillotts, Takeda, Arena, Kyowa Kirin, Adnovate, BioGaia and Pharmanovia; and speaker’s bureaus for Tillotts, Menarini, Kyowa Kirin, Takeda, Biocodex, AlfaSigma, Sanofi, Janssen Immunology, Pfizer, Ferrer, BioGaia and Falk Foundation.
Rights and permissions
About this article
Cite this article
Simrén, M. Targeting the gut microenvironment in IBS to improve symptoms. Nat Rev Gastroenterol Hepatol 20, 69–70 (2023). https://doi.org/10.1038/s41575-022-00718-3
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41575-022-00718-3
