Cleve Clin J Med. 2020 Jul 31;87(8):501-511. doi: 10.3949/ccjm.87a.19011.

Michael Kurin ^1 2, Gregory Cooper ^3 4 5

Author information

• ¹Digestive Health Institute, University Hospitals Cleveland Medical Center michael.kurin@uhhospitals.org.
• ²Case Western Reserve University School of Medicine, Cleveland, OH michael.kurin@uhhospitals.org.
• ³Digestive Health Institute, University Hospitals Cleveland Medical Center.
• ⁴Director of Gastroenterology and Hepatology Fellowship, University Hospitals Cleveland Medical Center.
• ⁵Professor, Department of Medicine, and Professor, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH.

Abstract

Irritable bowel syndrome (IBS) is a heterogeneous functional disease with a high prevalence and significant impact on quality of life. Traditionally understood as a pure disorder of brain-gut interaction, it is increasingly clear that IBS encompasses diverse pathologies, some of which involve objective alterations of intestinal structure, function, and the microbiome. IBS is subclassified as diarrhea, constipation, or mixed type based on the most prominent stool form. We review the diagnosis and management of the diarrheal type through a pathophysiologic lens, with attention to recent developments that can inform a mechanistically based targeted approach to treatment.