Hypothesis: Mechanism of irritable bowel syndrome in inflammatory bowel disease

Functional bowel symptoms can be occurred during remission from inflammatory bowel disease. In this case, a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet is effective for the amelioration or prevention of symptoms. However, the reason is not fully explai...

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Bibliographic Details
Published in:Medical hypotheses 2019-11, Vol.132, p.109324-109324, Article 109324
Main Author: Uno, Yoshiharu
Format: Article
Language:English
Subjects:
Diet
Disaccharides - metabolism
Fermentation
FODMAP
Humans
Hydrogen Sulfide - chemistry
Hydrogen-Ion Concentration
Inflammatory bowel disease
Inflammatory Bowel Diseases - physiopathology
Intestines
Irritable bowel syndrome
Irritable Bowel Syndrome - physiopathology
Ischemia
Mast cell
Mast Cells - metabolism
Monosaccharides - metabolism
Oligosaccharides - metabolism
Permeability
Polymers - metabolism
Pressure
Quality of Life
TRPV Cation Channels - metabolism
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Summary:Functional bowel symptoms can be occurred during remission from inflammatory bowel disease. In this case, a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet is effective for the amelioration or prevention of symptoms. However, the reason is not fully explained. This report proposes a hypothesis regarding the entire process in which inflammatory bowel disease with IBS-like symptoms (IBD-IBS) causes symptoms. A detailed process was assumed, starting from high pressure in the lumen and finally to abdominal symptoms. In this process, relationships were linked based on interactions such as ischemia, compliance, pain threshold, visceral hypersensitivity, mast cells, and permeability reported in IBD-IBS. In the process mapping, to understand the relationship between the amount of gas increased by FODMAP and ischemia, the hydrodynamic hypothesis and Ritchie’s hypothesis were adapted. Ischemia in dilated intestines due to an increase in gas volume can induce excessive spasms via the mast cells and show the whole process of lowering the pain threshold. From the standpoint of the mechanism of IBD-IBS, the origin trigger may be FODMAP. Therefore, a low-FODMAP diet is recommended to relieve and prevent IBD-IBS symptoms.
ISSN:0306-9877
1532-2777
DOI:10.1016/j.mehy.2019.109324