Intestinal secretory mechanisms in irritable bowel syndrome-diarrhea

Clin Gastroenterol Hepatol. 2015 Jun;13(6):1051-7; quiz e61-2. doi: 10.1016/j.cgh.2014.07.020. Epub 2014 Jul 17.


Although diarrhea is the predominant bowel dysfunction in as many as one-third of patients with irritable bowel syndrome (IBS), it is unclear whether there is a specific disorder of intestinal fluid or electrolyte secretion in IBS. Diarrhea is generally considered a result of accelerated colonic transit in patients with IBS. Although a primary secretory diathesis has not been well-documented in patients with IBS with diarrhea (IBS-D), several mechanisms that could potentially contribute to intestinal secretion have been reported. Some of these mechanisms also influence motor and secretory dysfunctions that contribute to the pathophysiology of IBS-D. We review the evidence supporting secretion in IBS-D caused by peptides and amines produced by enteroendocrine cells or submucosal neurons, enterocyte secretory processes, and intraluminal factors (bile acids and short-chain fatty acids). Understanding these mechanisms and developing clinical methods for their identification could improve management of patients with IBS-D.

Keywords: Absorption; Intestine; Pathogenesis; SCFA.

Publication types

  • Review

MeSH terms

  • Animals
  • Diarrhea / pathology*
  • Diarrhea / physiopathology*
  • Gastrointestinal Motility*
  • Humans
  • Intestinal Secretions*
  • Irritable Bowel Syndrome / pathology*
  • Irritable Bowel Syndrome / physiopathology*