Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder which presents with abdominal pain and altered bowel habits. It affects about 20% of the general population, mainly women, and has a considerable impact on the quality of life and health care costs. Four different entities of IBS have been identified: IBS with constipation (IBS‑ C), IBS with diarrhea (IBS D), IBS with a mixed pattern of constipation and diarrhea, and unclassified IBS. Although the precise pathogenesis of IBS remains unclear, its multifactorial nature is evident and includes environmental and host factors. Management of patients with this disease is challenging and a personalized approach is required. A strong, reassuring physician‑ patient relationship is crucial, followed by patient education, dietary advice, and stress reduction. For nonresponding patients, the therapeutic approach may include nonpharmacological therapies and / or pharmacotherapy. The choice of pharmacological treatment is based on the predominant symptom and a prespecified time point should be planned for effectiveness evaluation and dose adjustment. In patients with IBS‑ D, the therapeutic options include mainly antibiotics, such as rifaximin, peripheral opioid agonists, mixed opioid agonists / antagonists, bile acid sequestrants, and antagonists of serotonin 5‑ hydroxytryptamine type 3 receptors. Bulking agents and osmotic laxatives represent the first line therapy for IBS‑ C, while lubiprostone and linaclotide should be reserved for difficult to treat patients. The involvement of gastrointestinal microbiota constitutes a fascinating field of exploration as it offers the potential to be modulated by the use of probiotics, prebiotics, synbiotics as well as fecal microbiota transplantation. This review offers an updated overview on the recent advances in the treatment of IBS.

中文翻译：

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肠易激综合征治疗的最新进展。

肠易激综合征（IBS）是一种慢性功能性胃肠道疾病，表现为腹痛和排便习惯改变。它影响了大约 20% 的普通人群，主要是女性，并对生活质量和医疗保健费用产生了相当大的影响。已确定四种不同类型的 IBS：便秘型 IBS (IBS-C)、腹泻型 IBS (IBS D)、便秘和腹泻混合型 IBS 以及未分类的 IBS。尽管 IBS 的确切发病机制尚不清楚，但其多因素性质是显而易见的，包括环境和宿主因素。这种疾病患者的管理具有挑战性，需要个性化的方法。牢固、令人放心的医患关系至关重要，其次是患者教育、饮食建议和减轻压力。对于无反应的患者，治疗方法可能包括非药物疗法和/或药物疗法。药物治疗的选择基于主要症状，并应计划一个预先指定的时间点进行有效性评估和剂量调整。在 IBS-D 患者中，治疗选择主要包括抗生素，例如利福昔明、外周阿片受体激动剂、混合阿片受体激动剂/拮抗剂、胆汁酸螯合剂和 5-羟色胺 3 型受体拮抗剂。填充剂和渗透性泻药代表 IBS-C 的一线治疗，而鲁比前列酮和利那洛肽应保留用于难以治疗的患者。胃肠道微生物群的参与构成了一个迷人的探索领域，因为它提供了通过使用益生菌、益生元、合生元以及粪便微生物群移植来调节的潜力。这篇综述提供了关于 IBS 治疗最新进展的最新概述。