Predictors of irritable bowel syndrome exacerbations and targeted therapeutic strategies: a narrative review

Abstract

Background. Irritable bowel syndrome (IBS) is a chronic disorder, characterized by recurrent abdominal pain and disturbances in bowel habits. Also a low-FODMAP diet (LFD) is the first step in treatment, its universal application in all patients is not optimal; response rates range are from 50% to 80%.

Aim. Due to the highly heterogeneous nature of IBS, no definitive guidelines for treatment have yet been reached. We summarized the most important findings on this topic from the last decade. We identified specific predictors and then treatment strategies for specific patient groups.

Materials and Methods. A search of the PubMed and BASE databases (2016-2026) was conducted to identify full-text clinical studies and meta-analyses focusing on the relationship between IBS triggers, predictors of treatment response, and treatment results.

Results. The review identified various predictors across different domains. Important predictors of LFD success are: female gender, diagnosis confirmed by the Rome criteria, and clinical severity at baseline. From a microbiological perspective, high levels of Collinsella aerofaciens at baseline predict a positive response to specific probiotics. Bifidobacterium levels in the donor determine the success of fecal microbiota transplantation. Psychological aspects are also important; factors such as high anxiety related to symptom exacerbation, trust in the administered therapy, together with personality traits such as agreeableness, influence the effectiveness of behavioral therapies.

Conclusions. Treatment of IBS requires confirmation of the diagnosis (Rome criteria) and subsequent identification of individual predictive factors in order to implement individualized strategies including metabolic, microbiological and psychological profiling.