title: Irritable bowel syndrome: an integrated explanatory model for clinical practice.
abstract: BACKGROUND
  Although irritable bowel syndrome (IBS) is a symptom-based diagnosis, clinicians' management of and communication about the disorder is often hampered by an unclear conceptual understanding of the nature of the problem. We aimed to elucidate an integrated explanatory model (EM) for IBS from the existing literature for pragmatic use in the clinical setting.
  
  
  METHODS
  Systematic and exploratory literature searches were performed in PubMed to identify publications on IBS and EMs.
  
  
  RESULTS
  The searches did not identify a single, integrated EM for IBS. However, three main hypotheses were elucidated that could provide components with which to develop an IBS EM: (i) altered peripheral regulation of gut function (including sensory and secretory mechanisms); (ii) altered brain-gut signaling (including visceral hypersensitivity); and (iii) psychological distress. Genetic polymorphisms and epigenetic changes may, to some degree, underlie the etiology and pathophysiology of IBS and could increase the susceptibility to developing the disorder. The three model components also fit into one integrated explanation for abdominal symptoms and changes in stool habit. Additionally, IBS may share a common pathophysiological mechanism with other associated functional syndromes.
  
  
  CONCLUSIONS
  It was possible to elucidate an integrated, three-component EM as a basis for clinicians to conceptualize the nature of IBS, with the potential to contribute to better diagnosis and management, and dialog with sufferers.
authors.affiliation: School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK.
authors.forename: A P S
authors.initials: AP
authors.lastname: Hungin
authors.affiliation: School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK.|Research and Evaluation Unit, Oxford PharmaGenesis Ltd, Oxford, UK.
authors.forename: A
authors.initials: A
authors.lastname: Becher
authors.affiliation: Department of Family Medicine, University of Wisconsin, Madison, WI, USA.
authors.forename: B
authors.initials: B
authors.lastname: Cayley
authors.affiliation: Departments of Family Medicine and Urology, Medical School, University of Michigan, Ann Arbor, MI, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Heidelbaugh
authors.affiliation: Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
authors.forename: J W M
authors.initials: JW
authors.lastname: Muris
authors.affiliation: School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK.
authors.forename: G
authors.initials: G
authors.lastname: Rubin
authors.affiliation: Institute of General Practice, Charles University, Praha, Czech Republic.
authors.forename: B
authors.initials: B
authors.lastname: Seifert
authors.affiliation: Department of Anthropology, Durham University, Durham, UK.
authors.forename: A
authors.initials: A
authors.lastname: Russell
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: N J
authors.initials: NJ
authors.lastname: De Wit
mesh_terms: D064806:Dysbiosis / Q000150:complications* / Q000503:physiopathology; D000069196:Gastrointestinal Microbiome; D041981:Gastrointestinal Tract / Q000294:innervation* / Q000378:metabolism / Q000503:physiopathology; D020022:Genetic Predisposition to Disease; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D010353:Patient Education as Topic; D011110:Polymorphism, Genetic; D015398:Signal Transduction; D020886:Somatosensory Disorders / Q000150:complications* / Q000503:physiopathology; D013315:Stress, Psychological / Q000150:complications* / Q000523:psychology; D009435:Synaptic Transmission
keywords: explanations; explanatory models; irritable bowel syndrome; mechanisms