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  • Year in Review
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IBS in 2022

Targeting the gut microenvironment in IBS to improve symptoms

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.

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Fig. 1: The gut microenvironment and neuroimmune interactions are important for symptom generation in IBS and other DGBI.


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Correspondence to Magnus Simrén.

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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.

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Simrén, M. Targeting the gut microenvironment in IBS to improve symptoms. Nat Rev Gastroenterol Hepatol 20, 69–70 (2023).

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