A Key Role for the Small Bowel in Irritable Bowel Syndrome Pathophysiology: Time to Refocus?

We read the article by McOmber et al1McOmber M. al.Clin Gastroenterol Hepatol. 2020; 18: 375-384 e1Abstract Full Text PDF PubMed Scopus (5) Google Scholar with great interest. In this study, authors show that small intestinal permeability, measured ratio of orally ingested and urinary excreted lactulose/mannitol, is increased in first-degree relatives children irritable bowel syndrome (IBS) functional abdominal pain, whereas no differences were found for colonic or gastroduodenal permeability. This study provides additional evidence key role barrier dysfunction IBS. The hypothesis was based on previous findings indicate function impaired IBS patients, mostly patients diarrhea-predominant subtype (IBS-D).2Mujagic Z. al.Aliment Pharmacol Ther. 2014; 40: 288-297Crossref (78) Scholar,3Dunlop S.P. al.Am J Gastroenterol. 2006; 101: 1288-1294Crossref (374) Data permeability other subtypes remain inconclusive.2Mujagic Historically, has generally been considered a disorder large bowel, hence terminology, eg, spastic colon, nervous colon syndrome. However, accumulating suggests involvement entire gastrointestinal tract, including an important intestine. On cellular molecular level, several alterations tissue samples IBS, particular IBS-D, have shown. These include transcriptional post-transcriptional mechanisms, controlling tight-junction protein disrupted apical junctional complex integrity.4Martinez C. al.Gut. 2013; 62: 1160-1168Crossref (176) Scholar,5Robles A. al.Neurogastroenterol Motil. 2019; 31e13718Crossref (25) Furthermore, number mast cells epithelium compared healthy controls, which may modulate visceral sensitivity.5Robles Increased gut also associated hypersensitivity, defining characteristic IBS.6Zhou Q. al.Pain. 2009; 146: 41-46Abstract (266) Small distention indicating mechanosensation play role.7Accarino A.M. al.Gastroenterology. 1995; 108: 636-643Abstract (275) addition, recently we shown peppermint oil capsules release intestine greater beneficial effects symptom relief formulation,8Weerts 158: 123-136Abstract (37) supporting notion target treatment. conclusion, although difficult to current1McOmber findings2Mujagic Scholar, 3Dunlop 4Martinez 5Robles Scholar,7Accarino Scholar,8Weerts point organ pathophysiology be feasible focus new therapies. Uncovering exact relationship between generation will step understanding development yet still more research needed respect. Gut Permeability First-degree Relatives Children Irritable Bowel Syndrome Functional Abdominal PainClinical Gastroenterology HepatologyVol. 18Issue 2PreviewIncreased might contribute pathogenesis pain (IBS FAP). investigated whether siblings parents FAP Full-Text