[Irritable bowel syndrome: New pathophysiological hypotheses and practical issues]

Abstract

In 2015, besides the fact that it still fills the gastroenterologists' offices and impairs patient's quality of life, the irritable bowel syndrome has considerably evolved on several points. The pathophysiology is now organized around a consensual hypothesis called the "brain-gut axis", which gather all the influences of peripheral factors as gut microbiota or local serotonin secretion, on the central pain perception, contributing to visceral hypersensitivity and transit modifications. About the diagnosis, the key message is "avoid over-prescription" of additional tests, and reminds that a positive clinical diagnosis based on Rome III criteria is possible after the elimination of simple clinical warning signs. Finally, the food component, a neglected and historical claim of patients, finally finds a strong scientific rational, with a diet low in fermentable sugar and polyols, that gives positive and reproducible results.

Keywords: Axe cerveau-intestin; Brain-gut axis; Critères de Rome; FODMAP; FODMAPs; Gut microbiota; Hypersensibilité viscérale; Intestin irritable; Irritable bowel syndrome; Microbiote intestinal; ROME criteria; Serotonin; Sérotonine; Visceral hypersensitivity.