Pathophysiology of irritable bowel syndrome.

IBS lacks a definitive biomarker, but three decades of research have identified multiple peripheral and central pathophysiological abnormalities linked through the gut-brain axis.

• Why it matters: Without a reliable biomarker, it is hard to pinpoint specific targets for treatment, and most proposed mechanisms still lack dependable tests.
• What they did: This Review synthesizes evidence for peripheral mechanisms (e.g., infection, microbiome changes, visceral hypersensitivity, permeability, mucosal inflammation, motility, serotonin, bile acid and carbohydrate metabolism) and central mechanisms (psychological health, altered central pain processing).
• The result: Some mechanisms can be quantified with validated tests and questionnaires, including abnormal bile acid metabolism, accelerated colonic transit, and psychological comorbidity, but translation into reliable target-identifying tests remains incomplete.

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