Visceral hypersensitivity and diagnostic markers in functional gastrointestinal disorders: expert opinion

Puneet Mehrotra

doi:10.18203/2349-3933.ijam20243824

Authors

Puneet Mehrotra Department Gastroenterologist and Hepatologist, Aligram Main Rd, Lucknow, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20243824

Keywords:

Biomarkers, Gastrointestinal disorders, Irritable bowel syndrome, Rome IV criteria, Visceral hypersensitivity

Abstract

Functional gastrointestinal disorders (FGIDs), including irritable bowel syndrome (IBS), present diagnostic challenges due to the absence of specific biomarkers and reliance on symptom-based criteria like the Rome IV classification. IBS, characterized by abdominal discomfort, irregular bowel habits and bloating, affects up to 21% of populations globally, with varying prevalence across regions. Visceral hypersensitivity (VH) is a hallmark of IBS, particularly in diarrhea-predominant IBS (IBS-D), contributing to enhanced pain perception and gut dysmotility. VH involves complex mechanisms integrating peripheral and central nervous system pathways, affecting pain processing and emotional responses. Diagnostic approaches for IBS are hindered by overlapping symptoms with other gastrointestinal disorders and the dynamic nature of gut microbiota. Biomarkers, such as serum and fecal panels, gene expression profiles and psychological assessments, aim to enhance diagnostic accuracy and differentiate IBS subtypes. These biomarkers, including fecal calprotectin, short-chain fatty acids (SCFA), volatile organic compounds (VOCs) in breath tests and specific antibodies against microbial toxins, offer insights into the pathophysiology of IBS and aid in subtype prediction. Considering the scarcity of information on intricacies of VH in IBS and need gap in understanding the precise diagnostic markers for IBS, three physical focus group meetings were conducted with 25 expert gastroenterologists across India. Existing evidence and clinical experience with respect to the diagnosis of IBS, concept of visceral hypersensitivity and its importance in managing IBS, current treatment modalities and the role of various diagnostic biomarkers were discussed in detail by the experts and expert opinions were consolidated and finalized after approval by all participants.

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References

Simrén M, Törnblom H, Palsson OS, Tilburg MAL, Van Oudenhove L, Tack J, et al., Visceral hypersensitivity is associated with GI symptom severity in functional GI disorders: consistent findings from five different patient cohorts. Gut. 2018;67(2):255-62.

Lawate P. Expert opinion on current issues and challenges in irritable bowel syndrome. Int J Adv in Med. 2024;11(4):415-22.

Farzaei MH, Bahramsoltani R, Abdollahi M, Rahimi R. The role of visceral hypersensitivity in irritable bowel syndrome: pharmacological targets and novel treatments. J Neurogastroenterol Motil. 2016;22(4):558-74.

Gwee KA, Gonlachanvit S, Ghoshal UC, Chua ASB, Miwa H, Wu J, et al. Second Asian Consensus on Irritable Bowel Syndrome. J Neurogastroenterol Motil. 2019;1;25(3):343-62.

Pittayanon R, Lau JT, Yuan Y, Leontiadis GI, Tse F, Surette M, et al. Gut microbiota in patients with irritable bowel syndrome-a systematic review. Gastroenterol. 2019;157(1):97-108.

Dudzińska E, Grabrucker AM, Kwiatkowski P, Sitarz R, Sienkiewicz M. The importance of visceral hypersensitivity in irritable bowel syndrome—plant metabolites in IBS treatment. Pharmaceuticals. 2023;16(10):1405.

Ceuleers H, Van Spaendonk H, Hanning N, Heirbaut J, Lambeir AM, Joossens J, et al., Visceral hypersensitivity in inflammatory bowel diseases and irritable bowel syndrome: The role of proteases. World J Gastroenterol. 2016;22(47):10275-86.

Moloney RD, Johnson AC, O'Mahony SM, Dinan TG, Greenwood-Van Meerveld B, Cryan JF. Stress and the microbiota-gut-brain axis in visceral pain: relevance to irritable bowel syndrome. CNS Neurosci Ther. 2016;22(2):102-17.

Deiteren A, Wit A, Linden L, De Man JG, Pelckmans PA, De Winter BY. Irritable bowel syndrome and visceral hypersensitivity : risk factors and pathophysiological mechanisms. Acta Gastroenterol Belg. 2016;79(1):29-38.

De Palma G, Reed DE, Bercik P. Diet-microbial cross-talk underlying increased visceral perception. Gut Microbes. 2023;15(1):2166780.

Keszthelyi D, Troost FJ, Masclee AA. Irritable bowel syndrome: methods, mechanisms and pathophysiology. Methods to assess visceral hypersensitivity in irritable bowel syndrome. Am J Physiol Gastrointest Liver Physiol. 2012;15;303(2):141-54.

Kim JH, Lin E, Pimentel M. Biomarkers of Irritable Bowel Syndrome. J Neurogastroenterol Motil. 2017;30;23(1):20-6.

Nakov R, Snegarova V, Dimitrova-Yurukova D, Velikova T. Biomarkers in Irritable Bowel Syndrome: Biological Rationale and Diagnostic Value. Dig Dis. 2022;40(1):23-32.

Lembo AJ, Neri B, Tolley J, Barken D, Carroll S, Pan H. Use of serum biomarkers in a diagnostic test for irritable bowel syndrome. Aliment Pharmacol Ther. 2009;15;29(8):834-42.

Jones MP, Chey WD, Singh S, Gong H, Shringarpure R, Hoe N, et al. A biomarker panel and psychological morbidity differentiates the irritable bowel syndrome from health and provides novel pathophysiological leads. Aliment Pharmacol Ther. 2014;39(4):426-37.

Waugh N, Cummins E, Royle P, Kandala NB, Shyangdan D, Arasaradnam R, et al. Faecal calprotectin testing for differentiating amongst inflammatory and non-inflammatory bowel diseases: systematic review and economic evaluation. Health Technol Assess. 2013;17(55):1-211.

Baranska A, Mujagic Z, Smolinska A, Dallinga JW, Jonkers DM, Tigchelaar EF, et al. Volatile organic compounds in breath as markers for irritable bowel syndrome: a metabolomic approach. Aliment Pharmacol Ther. 2016;44(1):45-56.

Pimentel M, Morales W, Rezaie A, Marsh E, Lembo A, Mirocha J, et al., Development and validation of a biomarker for diarrhea-predominant irritable bowel syndrome in human subjects. PLoS One. 2015;10(5):126438.

Brenner DM, Lacy BE. Antispasmodics for Chronic Abdominal Pain: Analysis of North American Treatment Options. Am J Gastroenterol. 2021;1;116(8):1587-600.

Kruis W, Weinzierl M, Schüssler P, Holl J. Comparison of the therapeutic effect of wheat bran, mebeverine and placebo in patients with the irritable bowel syndrome. Digestion. 1986;34(3):196-201.

Wittmann T, Paradowski L, Ducrotté P, Bueno L, Delestrain MC. Clinical trial: the efficacy of alverine citrate/simeticone combination on abdominal pain/discomfort in irritable bowel syndrome--a randomized, double-blind, placebo-controlled study. Aliment Pharmacol Ther. 2010;31(6):615-24.

Baldi F, Longanesi A, Blasi A. Clinical and functional evaluation of the efficacy of otilonium bromide: A multicenter study in Italy. Ital J Gastroenterol. 1991;23:60–3.