The growing case for an immunological component to irritable bowel syndrome

Abstract

It is now generally accepted that irritable bowel syndrome (IBS) is a multifactorial condition with a variety of mechanisms being involved in its pathogenesis. In addition to psychological influences, which have probably been somewhat over-rated in the past, abnormalities of motility, visceral sensation as well as the central processing of noxious stimuli have been demonstrated [1]. The condition undoubtedly runs in families suggesting a genetic component and there is increasing evidence for the presence of low-grade inflammation in the gastrointestinal mucosa of at least a proportion of individuals. Dietary factors are also important and it is common for patients to complain that their symptoms are particularly troublesome following a meal. As a consequence they frequently conclude that they must have some form of dietary allergy, they certainly want to discuss the role of food in their condition and usually ask for a diet sheet. In addition, patients are now often seeking, finding and spending a lot of money on commercially available allergy tests of extremely questionable validity.