Pathophysiology-driven use of natural products in irritable bowel syndrome: a review

Irritable bowel syndrome (IBS) is a highly prevalent disorder of gut-brain interaction characterized by chronic abdominal pain associated with altered bowel habits, including constipation-predominant (IBS-C), diarrhea-predominant (IBS-D), mixed (IBS-M), and unsubtyped forms. The pathophysiology of IBS is believed to be multifactorial as it involves dysregulation of the gut-brain axis, visceral hypersensitivity, serotonergic imbalance, epithelial barrier dysfunction, immune activation, dysbiosis, bile acid alterations, in addition to psychosocial stressors. These interacting mechanisms are known to be involved in the generation of persistent symptoms as well as the widely reported clinical heterogeneity of the disease. Current management strategies include dietary modification, psychological therapies, microbiota-targeted approaches, and pharmacological agents targeting the prevalent symptom subtype. However, treatment responses remain variable, and many patients seek complementary and natural interventions to alleviate their symptoms. Emerging evidence suggests that natural products may exert therapeutic benefits through anti-inflammatory actions, modulation of serotonergic signaling, improvement of intestinal barrier integrity, microbiota regulation, and neuromodulatory effects. Clinical studies demonstrate that certain natural interventions, particularly peppermint oil, STW 5 (Iberogast), psyllium, and several selected probiotics, can provide modest but clinically meaningful symptom improvement, especially for abdominal pain. Nonetheless, heterogeneity in trial design, short durations, small sample sizes, and limited subtype stratification restrict the strength of the resulting recommendations. This review provides a comprehensive overview of IBS pathophysiology, current treatment strategies, and mechanistic and clinical evidence supporting natural products in IBS management, while highlighting critical gaps and future research priorities.