Current insights into the pathophysiology of irritable bowel syndrome.
Recent reports have emphasized the possible role of mucosal immune activation and inflammation in neuropathic changes in the pathophysiology of irritable bowel syndrome (IBS). However, novel findings using functional brain imaging techniques have underlined the importance of altered perception of visceral stimuli to symptom generation in IBS. These new developments have rekindled an old debate on peripheral versus central mechanisms in the pathophysiology of IBS. In this review we discuss the latest findings in light of these two concepts. In addition, we provide evidence for the hypothesis that, in the absence of alterations in endogenous pain modulation systems and changes in visceral perception, chronic inflammatory mucosal changes in the gut are not a plausible mechanism to explain the presence of chronic abdominal pain, a cardinal IBS symptom.
Schwetz
Ines
I
Center of Neurovisceral Sciences and Women's Health, CURE: Digestive Diseases Research Center, David Geffen School of Medicine at UCLA, VAGLAHS, Bldg. 115, Room 223, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA. emayer@ucla.edu
Bradesi
Sylvie
S
Mayer
Emeran A
EA
D003109:Colonic Diseases, Functional / Q000276:immunology* / Q000503:physiopathology* / Q000628:therapy; D006801:Humans