Irritable bowel syndrome with constipation (IBS-C) is a common subtype of functional bowel disorder associated with substantial symptom burden and reduced quality of life. Management typically begins with dietary and lifestyle modification, laxatives, and antispasmodics; however, many patients experience inadequate relief, underscoring the need for more effective therapies. Linaclotide, a synthetic guanylin analog, is an established treatment for IBS-C. By activating guanylate cyclase-C (GCC) receptors on intestinal epithelial cells, it promotes intestinal fluid secretion, accelerates transit, and alleviates visceral hypersensitivity. Randomized controlled trials have demonstrated its efficacy and favorable safety profile, with mild-to-moderate diarrhea and abdominal pain being the most common adverse events. Because clinical trial populations may not fully reflect real-world patient diversity, real-world evidence (RWE) provides valuable complementary data. This review summarizes current RWE on linaclotide in IBS-C, integrating findings from multiple studies to present a comprehensive view of its effectiveness and safety in routine clinical practice.

The gastrointestinal tract harbours a vast chemical diversity of small molecules, consisting of dietary nutrients, microorganism-derived metabolites and metabolic products of the host. The latest evidence highlights a direct involvement of different metabolites in the diverse aetiologies of intestinal diseases, ranging from inflammatory to metabolic and neoplastic conditions. The accessibility of the gastrointestinal tract to oral intervention suggests that fine-tuning the levels of intestinal metabolites might be a promising and currently underutilized therapeutic strategy. Here, we provide a conceptual overview of the recurring mechanistic themes by which metabolites shape the biology of immune cells, epithelium and neurons of the gastrointestinal tract. Additionally, we classify metabolites according to possible categories of therapeutic intervention, and summarize the latest preclinical and clinical data unveiling the roles of intestinal metabolites in the pathophysiology of major diseases of the gastrointestinal tract, including inflammatory bowel disease, irritable bowel syndrome, colorectal cancer, enteric infection, food allergy, coeliac disease, as well as obesity and metabolic syndrome. In each case, we provide an overview of the mechanisms by which intestinal metabolites have been associated with disease aetiology. In addition, we discuss possible metabolite-based strategies for intervention. Our overall goal is to provide a roadmap towards developing metabotherapies for intestinal disease.

Hyaluronic acid-ethylenediamine-cinnamic acid attenuates IBS-D via regulating 5-hydroxytryptamine signaling pathway, intestinal barrier and gut microbiota.

Evaluating a mobile-enhanced cognitive behavioral therapy program for university students with irritable bowel syndrome.

Polysaccharide structural differences in Shenling Baizhu formulations and their therapeutic effects in ulcerative colitis and irritable bowel syndrome.

Biomarkers in Irritable Bowel Syndrome: Rationale and Practical Use.

Glucocorticoid signaling mitigates colitis-associated visceral hypersensitivity by suppressing 5-HT release in enterochromaffin cells via a GR-PI3K-SGK1 axis.

The role of pain catastrophizing in modulating irritable bowel syndrome symptoms through brain-spinal cord integration

Introduction: Irritable Bowel Syndrome (IBS) is a common functional gastrointestinal disorder, with a significant impact on quality of life, particularly among young adults. The objective was to determine the prevalence and associated factors of IBS among students at Université des Montagnes (UdM), Cameroon. Methods: A cross-sectional study was conducted from February to May 2024 among 450 students from the Banekane campus, UdM. The sampling method used was cluster sampling. The diagnosis of IBS was based on the Rome IV criteria. Data analysis was performed using SPSS 20.0 software. Associated factors were identified by multivariate logistic regression (p < 0.05). Results: The prevalence of IBS was 17.6%. The IBS-C subtype was predominant (44%). Factors significantly associated with IBS included: regular alcohol consumption (OR = 1.79; 95% CI [1.08-2.9], p = 0.02), magnesium-rich diet (OR = 1.64; 95% CI [1-2.69], p = 0.049), probiotics (OR = 6.64; 95% CI [2.81-15.68], p < 0.001), and soluble fiber intake (OR = 1.46; 95% CI [1-2.69], p = 0.049). Conclusion: IBS is common among UdM students. Specific diet and consumption habits may influence its onset. Nutritional awareness and early management are necessary.

Background: Irritable bowel syndrome is an important form of functional bowel disease. Mebeverine is a well-known antispasmodic that has been successfully used for many years to treat IBS. The preference for utilizing selective serotonin reuptake inhibitors is frequently significant because psychological issues are associated with the etiology of IBS. Objectives: The study aimed to examine the effect of adding Fluoxetine as adjuvant therapy to Mebeverine on symptoms of irritable bowel syndrome. Materials and Methods: This study examined the effects of fluoxetine 20 mg capsule and Mebeverine 135 mg tablet on IBS symptoms. A total of 44 patients were recruited into the study. Twenty-one patients were given 135 mg of Mebeverine twice daily before meals by the doctor, and twenty-three patients were given 20 mg of fluoxetine once daily at bedtime in addition to 135 mg of Mebeverine twice daily before meals for two weeks. Results: After two weeks of treatment with Mebeverine and fluoxetine there was a highly significant drop in the proportion of patients who reported substantial abdominal pain, and significant urgency (P < 0.01), which was absent in the group receiving Mebeverine (P>0.05) only. Both study groups had highly significant reductions in flatulence and stomach bloating within the first two weeks of treatment (P < 0.01). Conclusion: The findings revealed a highly significant and substantial decline in the abdominal pain, abdominal bloating, flatulence and substantial urgency in the group receiving both drugs (Mebeverine and fluoxetine) which result in more relief of irritable bowel symptoms in those patients.

Irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO) share symptoms such as abdominal pain, bloating, and altered bowel habits. Both are linked to dysbiosis and gut–brain axis dysfunction. IBS is a multifactorial disorder characterized by abnormal motility, visceral hypersensitivity, low-grade inflammation, and alterations in the microbiota. In contrast, SIBO is defined by excessive bacterial colonization of the small intestine that can mimic or worsen IBS symptoms. Gut microbes and their metabolites influence motility, immune activation, barrier integrity, and gas production; methanogen overgrowth is associated with constipation-predominant presentations, while hydrogen- and hydrogen sulfide-related pathways may contribute to diarrhea and bloating. Because recurrent or empiric antibiotic use is common—particularly in suspected SIBO—yet carries risks of resistance, microbiome disruption, and relapse, there is a strong rationale to prioritize effective non-antibiotic strategies. Accordingly, this review synthesizes current evidence on IBS/SIBO pathophysiology and microbiota interactions. It evaluates non-pharmacological interventions including dietary approaches, probiotics/prebiotics, herbal therapies, and mind–body treatments (e.g., cognitive behavioral therapy and gut-directed hypnotherapy). We emphasize an integrative framework that supports symptom control and quality of life while helping reduce unnecessary antibiotic exposure.

Background Individuals with irritable bowel syndrome (IBS) are at an elevated risk for mental disorders. However, IBS management often overlooks psychological factors, which may contribute to suboptimal therapeutic outcomes. Objective This study aims to assess the current treatment approach for IBS at our center, Jinling Hospital of Nanjing and investigate whether dietary interventions, specifically the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet (low FODMAP diet; LFD), could alleviate anxiety symptoms in IBS patients. Methods We prospectively enrolled two cohorts of IBS patients. The first cohort underwent an observational study to assess the prevalence of anxiety and evaluate current treatment approaches. The second cohort participated in a clinical trial evaluating the efficacy of the LFD. Stool samples were collected before the LFD intervention and analyzed using 16S rRNA sequencing. Results Anxiety was present in approximately 60% of IBS patients in our cohort, but it was frequently overlooked in conventional treatment. Anxiety was positively correlated with IBS symptom severity. Rifaximin was the only standard therapeutic option demonstrating efficacy. A one-month LFD intervention significantly reduced both gastrointestinal and mental health symptoms in IBS patients. Although α- and β-diversity of the gut microbiota were similar between diet responders and nonresponders, the composition of dominant bacteria differed significantly. At the genus level, responders exhibited higher abundances of Klebsiella, Parabacteroides, and Lactobacillus than non-responders. Conclusion Anxiety is common in IBS patients but often neglected in standard treatment protocols. The LFD may serve as an alternative therapeutic approach, potentially exerting benefits through modulation of gut microbiota.

Commentary: Clarifying the Evidence for Microbial Mechanisms and Dietary Management in Irritable Bowel Syndrome

Background/Objectives: Irritable bowel syndrome (IBS) is a common and heterogeneous gastrointestinal disorder. Although numerous systematic reviews (SRs) have evaluated the effects of probiotics in IBS, uncertainty persists regarding their clinical effectiveness, methodological quality, and certainty of evidence. This umbrella review aimed to critically appraise SRs on probiotics in IBS, quantify overlap among reviews, and assess the certainty of evidence using the GRADE approach. Methods: We conducted an umbrella review of SRs of randomized controlled trials evaluating probiotics in adults with IBS. Searches were performed in MEDLINE/PubMed, Embase, the Cochrane Database of Systematic Reviews, Scopus, and Web of Science from inception to September 2025. Overlap between reviews was assessed using the corrected covered area (CCA). Methodological quality was evaluated with AMSTAR-2, risk of bias with ROBIS, and certainty of evidence with GRADE. Results: Twenty-seven SRs published between 2009 and 2025 were included, encompassing 5–82 randomized trials and 243–10,332 participants per review. Methodological quality was low or critically low across all SRs, with 66.7% rated as critically low by AMSTAR-2 and 85.2% judged at high risk of bias by ROBIS. A high degree of overlap was observed between reviews (CCA: 12%). Probiotics were associated with modest improvements in symptom persistence (risk ratio ≈ 0.78–0.79; number needed to treat 4–7), small-to-moderate effects on abdominal pain (standardized mean difference −0.31 to −0.94) with substantial heterogeneity, and small or inconsistent effects on bloating and quality of life. Adverse events were comparable to placebo. Overall, certainty of evidence was predominantly low or very low, with only 1% of outcomes rated as high certainty. Conclusions: Although probiotics demonstrate statistically significant benefits for some IBS outcomes, the certainty of evidence remains predominantly low or very low due to methodological limitations, inconsistency, imprecision, and substantial overlap between reviews. The accumulation of redundant SRs has not increased confidence in effect estimates. Future efforts should prioritize well-designed, standardized primary trials rather than additional systematic reviews.

Introduction Irritable bowel syndrome (IBS) has been linked to poor health, high stress and diminished quality of life. Previous findings about associations between IBS and cardiovascular disease are, however, contradictory. Our objective was to examine 10-year cardiovascular risk, lifestyle factors, and self-rated health in people with IBS compared to a reference group. Methods Sweden's southernmost county (Scania) has implemented targeted health dialogues (THDs) in primary health care for all 40- and 50-year-olds. Before the THD, participants completed a questionnaire about their health and lifestyle. Cholesterol, blood glucose, BMI and waist-hip-ratio were measured. Participants were also invited to a research project. The present study used baseline variables from 2021 to 2024 to examine the 10-year risk of cardiovascular events according to SCORE2, four health behaviors (diet, physical activity, smoking and alcohol), and self-rated health in THD-participants with and without IBS. Analyses took into account sex, level of education and place of birth. Results The study population comprised 8 899 (56.5%) THD participants of which 592 (6.7%) had a diagnosis of IBS. Participants with IBS did not show an increased 10-year cardiovascular risk after adjusting for confounders. However, men with IBS had higher mean diastolic blood pressure ( p = 0.030), and women with IBS had higher mean waist-hip-ratio compared to the reference group ( p = 0.013). There were no overall differences shown in physical activity, smoking, or diet between participants with/without IBS, but women with IBS consumed less alcohol ( p = 0.026). Poor self-rated health was significantly more common in both women and men with IBS ( p < 0.001). Conclusion IBS was not associated with an increased 10-year cardiovascular risk in this population, but further research is needed, preferably subtype-specific. THDs and similar interventions may provide opportunities to identify needs for healthcare support in people with IBS suffering from poor self-rated health.

Gender-dependent preferences of medical professionals in treatment choices for irritable bowel syndrome: results from an exploratory study.

High-definition anorectal manometry (HD-ARM), balloon expulsion test (BET), and magnetic resonance defecography (MR defecography) are important tools in studying constipation. Our aim was to evaluate the prevalence of functional defecation disorders and structural anorectal alterations in patients with chronic constipation and compare the findings of HD-ARM and BET with MR defecography. Retrospective cohort study including patients with functional constipation or irritable bowel syndrome with constipation (IBS-C), refractory to medical therapy, submitted to HD-ARM, BET, and MR defecography. Patients were divided into three groups: (a) normal anorectal evacuation in HD-ARM and normal BET; (b) abnormal evacuation pattern and abnormal BET; and (c) normal anorectal evacuation pattern and abnormal BET, or abnormal evacuation pattern and normal BET. A total of 64 patients were included, 49 with functional constipation (76.6%) and 15 with IBS-C (23.4%). In MR defecography, 47 patients had structural alterations (73.4%) and 15 had dyssynergia (23.4%). Overall, 19 patients were diagnosed with dyssynergic defecation (29.7%). Comparing the findings of HD-ARM and BET with MR defecography: in group 1 (n = 20), 15 patients had structural alterations (75.0%); in group 2 (n = 11), 8 had structural alterations (72.7%); and in group 3 (n = 33), 22 patients only had structural alterations (66.7%), 6 only had dyssynergic defecation (18.2%), and 2 had both (6.0%). MR defecography allowed the diagnosis of dyssynergic defecation in 8 patients (24.2%). One third of patients with functional constipation and IBS-C had dyssynergic defecation and three quarters had relevant structural anorectal alterations. Therefore, it is important to combine MR defecography with HD-ARM and BET in the study of constipation.

Probiotic therapeutics: A critical review of mechanisms, clinical efficacy, and the frontier of precision microbiome modulation.

ABSTRACT Youth with gastrointestinal (GI) conditions often experience higher rates of mental health concerns, social challenges, and family dysfunction compared to healthy peers. It is important to investigate how these children and their parents fared during the COVID-19 pandemic. This study aims to identify trajectories of well-being and predictors of the trajectories during the COVID-19 pandemic for children with GI conditions and their parents. Biopsychosocial survey data was collected three times from children (n = 55) with irritable bowel syndrome, inflammatory bowel disease, and celiac disease and one of their parents (n = 58) from September 2020 – December 2022. Latent variables of well-being were constructed, and trajectories were identified with visual and statistical methods. Binomial regression identified predictors of resilience trajectories. Participants fell into five trajectory groups: resilience, improving, worsening, chronic, and time 2 variation. Most children and parents were in the resilience trajectory group. Exploratory analyses revealed a strong parent-child relationship predicted which children belonged to the resilience trajectory, and low isolation predicted which parents belonged to the resilience trajectory. Clinicians should assess mental health concerns at each visit; well-being fluctuated throughout the height of the pandemic. Leveraging a strong parent-child relationship could help support child resilience responses at times of high stress.

Current classification systems for irritable bowel syndrome (IBS) based on bowel habit do not consider psychological impact. We applied a previously validated latent class analysis (LCA) model to a cohort of patients with IBS in secondary and tertiary care to assess whether it predicted levels of healthcare utilisation. We applied our LCA model to a referral population with IBS. As described previously, we assigned cluster membership based on gastrointestinal symptom severity and psychological burden. We assessed demographics, symptom severity and quality of life at baseline and levels of healthcare utilisation during 12 months of longitudinal follow-up according to cluster. We recruited 379 patients, of whom 249 (65.7%) met the Rome IV criteria. Those in the four clusters with higher psychological burden had more severe symptoms on the IBS-SSS and lower quality of life scores (p < 0.001 for both). Rates of discharge were generally lower in clusters with higher psychological burden (p = 0.05). Rates of prescribing a drug for IBS (p = 0.001), the mean number of drugs prescribed for IBS (p < 0.001) and the mean number of different drug types prescribed for IBS (p < 0.001 for trend) were highest in the four clusters with higher psychological burden. In patients with IBS in secondary and tertiary care, the LCA model identified groups of individuals with more severe symptoms and greater impairments in quality of life at baseline and significantly higher rates of healthcare utilisation during longitudinal follow-up.