Autonomic nervous system dysfunction in irritable bowel syndrome: pathophysiology and therapeutic implications

Area of Science:

• Gastroenterology
• Neuroscience
• Autonomic Medicine

Background:

• Irritable bowel syndrome (IBS) is frequently associated with autonomic nervous system (ANS) dysfunction.
• Patients with IBS often display a sympathovagal imbalance, characterized by reduced vagal tone and sympathetic hyperactivity, which correlates with symptom severity and IBS subtypes.

Purpose of the Study:

• To review and synthesize current evidence on autonomic nervous system (ANS) dysfunction in irritable bowel syndrome (IBS).
• To explore the mechanisms linking ANS dysfunction to IBS pathogenesis and symptomology.
• To discuss emerging therapeutic strategies targeting autonomic circuits in IBS.

Main Methods:

• Systematic review of current scientific literature.
• Synthesis of evidence on ANS dysfunction in IBS.
• Analysis of brain-gut interactions, neuroinflammation, and microbiota roles.

Main Results:

• ANS dysfunction, particularly sympathovagal imbalance, is a significant feature in IBS patients.
• Bidirectional brain-gut communication, influenced by psychosocial factors, neuroinflammation, and the gut microbiota, is mediated by the ANS.
• Mechanisms include vagal afferent signaling, sympathetic immune regulation, stress responses, and neuroplasticity.

Conclusions:

• Emerging evidence supports targeting autonomic circuits for IBS treatment, including vagus nerve stimulation, pharmacological interventions, and microbiome-based therapies.
• Challenges remain in assessing neural dynamics and integrating multi-system interactions.
• Future research should utilize multi-omics approaches for precision medicine strategies in heterogeneous IBS populations.