Actionable Clinical Features and Biomarkers to Facilitate the Management of Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a common, chronic disorder of gut-brain interaction (DGBI) that is characterized by core clinical features of abdominal pain and altered bowel movements. Because IBS remains defined by symptom patterns, most clinical care for patients with IBS relies on treatments directed by IBS subtype. Although the biopsychosocial model has advanced DGBI research and clinical care, and the current Rome IV criteria have greatly helped the diagnostic paradigm for IBS, the model does not identify specific pathophysiological mechanisms that operate in any one patient. Consequently, most interventions for IBS benefit only subsets of patients, and patients often progress through a series of ‘trial and error’ approaches to manage their IBS symptoms. There is a major clinical need to develop a practical basis for a personalized medicine approach in IBS care. In this article, we discuss how clinicians may incorporate additional clinical features and actionable biomarkers to better inform the initial choice of therapy for patients with IBS. Ideally, such a mechanistic approach should be more efficient, and ultimately more effective, leading to improved patient satisfaction and clinical outcomes.