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Irritable Bowel Syndrome (IBS) is one of the most common functional disorders of the digestive system, affecting approximately 10% of the world’s population. Although it is not a dangerous disease and does not increase the risk of colon cancer, it can significantly affect the quality of life, limiting the professional, social and personal activity of patients.

Scientific knowledge about irritable bowel syndrome has evolved significantly in recent years. Today we know much more about the mechanisms that cause it and we have more effective, personalized treatment options.

What are the symptoms?

Irritable Bowel Syndrome is characterized by recurrent abdominal pain, which is related to bowel movements and is accompanied by changes in bowel function.

Depending on the type of syndrome, patients may experience:

• diarrhea
• constipation
• alternating diarrhea and constipation

Often coexisting:

• severe bloating
• increased gas
• feeling of incomplete evacuation
• discomfort after meals

Symptoms vary significantly from patient to patient and usually show periods of remission and exacerbations.

It is not “in our minds”

Until a few years ago, the misconception prevailed that irritable bowel syndrome was mainly a psychological disorder. Today we know that this is a real disorder of intestinal function, the result of the complex interaction between:

• the brain
• the enteric nervous system
• the microbiome
• the immune system
• diet
• hormones
• and genetic predisposition

There is no single cause. On the contrary, it is a syndrome in which many different mechanisms coexist and interact.

The brain-gut axis

The so-called brain-gut axis, i.e. the continuous communication between the central nervous system and the nervous system of the intestine, seems to play a central role.

The intestine has millions of nerve cells and is not unfairly described as the “second brain”. When this communication is disrupted, the gut becomes hypersensitive even to normal stimuli, such as the presence of gas or bloating after a meal.

At the same time, intestinal motility is disrupted, causing either diarrhea or constipation.

The important role of the microbiome

In recent years, the gut microbiome, i.e. the trillions of microorganisms that normally inhabit the gut, has attracted particular scientific interest.

The microbiome participates in:

• digestion
• immune regulation
• production of substances that even affect brain function

In several patients with irritable bowel syndrome, a disturbance of the normal balance of the microbiome (dysbiosis) is found, which contributes to the appearance of bloating, gas and abdominal pain.

In some cases, mild inflammation or increased permeability of the intestinal mucosa is also observed, especially after episodes of gastroenteritis.

How is the diagnosis made?

The diagnosis is no longer a diagnosis of “exclusion”, as was the case in the past.

The gastroenterologist can now make the diagnosis based on:

• • the characteristic symptoms
  • the international Rome IV

criteria

• the detailed medical history
• and the clinical examination

Where necessary, basic blood tests, a test for celiac disease and a measurement of calprotectin in the stool are performed to exclude other organic diseases.

Colonoscopy is not required in all patients. It is indicated when there are worrying symptoms, such as:

• blood in the stool
• unexplained weight loss
• anemia
• nocturnal diarrhea
• family history of colon cancer
• or first appearance of symptoms after the age of 50

How much does stress affect it?

Stress is not the only cause of irritable bowel syndrome, but it can significantly worsen symptoms.

During periods of intense stress, cortisol production increases and the autonomic nervous system is activated, affecting:

• intestinal function,
• pain perception,
• but also the intestinal microbiome.

Thus a vicious cycle is created: stress worsens symptoms and symptoms increase anxiety.

For this reason, modern Treatment includes, where appropriate:

• stress management techniques
• regular exercise
• adequate sleep
• psychological support
• cognitive-behavioral therapy

Why does it affect women more?

Women experience the syndrome almost twice as often as men.

Hormonal changes affect both bowel motility and sensitivity. Many women notice a worsening of symptoms shortly before or during menstruation.

Similarly, perimenopause and menopause are periods in which estrogen changes, combined with sleep disturbances, hot flashes, and increased psychological stress, can affect the brain-gut axis and even lead to the first appearance of symptoms.

Modern treatment

Treatment is always individualized and adapted to the needs of each patient.

Diet is the foundation

Identifying foods that cause discomfort, avoiding large and fatty meals, limiting caffeine and alcohol, and gradually increasing soluble fiber can provide substantial relief.

In patients with severe bloating, the low-FODMAP diet has proven to be particularly effective, but it should only be implemented under the guidance of a specialized dietitian.

Medication

When diet is not sufficient, there are effective treatment options, such as:

• antispasmodics for abdominal pain,
• specialized medications for constipation or diarrhea,
• antidepressants in low doses, which are used not to treat depression but because they reduce intestinal hypersensitivity and modify pain perception.

What is the role of probiotics?

Probiotics are another therapeutic tool, but not a panacea.

Not all probiotics have the same effectiveness. Their effect depends on:

• the specific strain
• the dosage
• the duration of administration

Some strains have been shown to reduce bloating, gas and abdominal pain, improving overall quality of life. They are usually administered for a period of 4–8 weeks and are continued only when there is a clear clinical benefit.

Conclusion

Irritable Bowel Syndrome is a chronic but completely manageable condition. Although there is no definitive cure, most patients can achieve significant improvement in their daily lives when an individualized therapeutic approach is implemented that combines proper nutrition, lifestyle changes, stress management and, where necessary, medication or probiotics.

Modern gastroenterology now views irritable bowel syndrome not as a “vague” or “psychological” condition, but as a complex disorder in which the gut, brain, microbiome, hormones, and immune system interact. A better understanding of these mechanisms now allows for more targeted treatments and empowers patients to regain control of their daily lives and substantially improve their quality of life.