Introduction:
Gut health is one of the key indicators of a healthy lifestyle. Irritable bowel syndrome is a chronic and functional disorder of the gastrointestinal tract. It is characterized by altered bowel movements. Around 5 to 10 percent of the world's population suffers from this chronic condition. Over the years, several therapeutic techniques have been used for the treatment of irritable bowel syndrome. Biological therapies are the newest treatment form used to cure this condition.
What Is Inflammatory Bowel Disease?
Inflammatory bowel disease is a chronic inflammatory disease of the small intestine. This inflammation is caused by the abnormal immune response by the gut microflora. This includes two pathological conditions, which are ulcerative colitis and Crohn’s disease.Excessive expression of the inflammation leads to the destruction of the epithelial lining and causes intrusion of the bacteria and antigens and other substances in the bloodstream.
The pathogenesis of inflammatory bowel disease is multifactorial. These factors are:
1. Genetics:
Genetics plays a crucial role in the pathogenesis of inflammatory bowel disease. The NOD2 gene is associated with Crohn’s disease. Also, genes like IBD5, IL23R, and ATG16L1 are also associated with Crohn’s disease. Alteration of the functioning of these genes is responsible for the expression of alteration in the expression of cytokine synthesis, autophagy properties, and phagocytosis.
2. Environmental Factors:
Different environmental factors play major roles in the pathogenesis of inflammatory bowel diseases. Factors like food, diet, drugs, geography, social stress, and psychological problems lead to inflammatory bowel disease. In recent studies, it has been seen that vitamin D deficiency and calcium are associated with inflammatory bowel disease. Fatty food, high protein diet, spicy food, and excessive intake of dairy products are associated with this disorder. Drugs like excessive intake of non-steroidal anti-inflammatory drugs and antibiotics at an early age increase the risk of this type of chronic inflammation. Psychological factors like post-traumatic stress disorder, depression, and anxiety are considered risk factors in such cases. This is regarded as a gut-brain axis abnormality. This causes the difference in the alteration in the brain structure, connectivity, and functional responsiveness. Endocrine, neural, and neuroimmune abnormalities are also associated with visceral abnormalities.
3. Microbial Factors:
The intestinal microbiota is essential in maintaining gur health. Alteration of gut microbiota is seen in inflammatory bowel disorder. Microbiota like Faecalibacterium
Prausnitzii, Ruminococcus albus, and Ruminococcus gnavus are decreased in this condition. On the other hand, an increased amount of microorganisms like Ruminococcus bromii, Roseburia, Escherichia coli, and Eubacterium rectale can be observed.
4. Immune Factors:
Dysfunctioning of innate and adaptive immunity is associated with inflammatory bowel disorder. This alteration in the immune response is associated with altered functioning and differentiation of the T- lymphocytes. As a result, Th1 and Th17 cells are formed due to the differentiation of lymphocytes. The altered functioning of Innate lymphoid cells is also responsible for this condition.
What Are the Symptoms of Inflammatory Bowel Disease?
The usual symptoms of inflammatory bowel disease are:
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Lower abdominal pain or pain in the lower back portion. The pain is chronic in nature and intermittent in nature.
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Abdominal bloating is sometimes seen.
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An altered stool pattern is observed. Some patients complain of constipation and some diarrhea.
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Excessive gas formation in the abdomen.
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Presence of mucus with the stool.
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History of food which triggers the
What Are the Treatment Options?
The treatment protocol for irritable bowel syndrome can be divided into several types. These are:
A. Non-Pharmacological Treatment Protocol:
Food is responsible for the stimulation of the chemo and mechanoreceptors via osmotic actions. One of the most commonly used approaches is diet modification. Persons often suffer from irritable bowel syndrome suspectable to gluten, wheat, lactose, and fermentable oligosaccharides intolerant. In such cases often, fructose malabsorption can be observed. Such food should be excluded from the diet. Soluble fiber diets have proved to be beneficial in such cases. The administration of microorganisms can be proven to be helpful in the improvement of gut health. Microorganisms like Lactobacillus casei, Lactobacillus planatarum, Lactobacillus bulgaricus, Lactobacillus acidophilus, and Bifidobacterium longum are administered as probiotics. Increased physical activity, exercise, and meditation can help to reduce stress. Congestive behavioral therapy has proven to be effective in reducing stress and anxiety in controlling irritable bowel syndrome.
B. Pharmacological Interventions:
Medicines like antispasmodics, peppermint oil, and selective serotonin reuptake inhibitors (SSRIs) can be used to reduce abdominal pain. In case of diarrhea, medications like Loperamide or probiotics can be helpful. Constipation can be treated using fiber supplements and laxatives. In certain cases, antibiotics like Rifaximin can be used to control diarrhea. 5-aminosalicylic acid, corticosteroids, and immunomodulators can be used to control inflammation.
What Is the Role of Biological Therapies in Irritable Bowel Syndrome?
Biological therapies include the use of biological products like proteins, peptides, and hormones to treat different conditions. Different biological therapies used for the treatment of irritable bowel syndrome are:
1. Anti-TNF-Alpha Therapy:
Tumor necrosis factor-alpha is a type of cytokine that helps in various biological functions like cell proliferation, cell survival, and cell death. This chemical substance is produced in response to inflammation in various disease conditions like irritable bowel syndrome. Tumor necrosis factor-alpha antibodies can be helpful enough in reducing the levels of these harmful chemical mediators. Antibodies like Infliximab, Adalimumab, Golimumab, and Certolizumab pegol prevent the pro-inflammatory signal transformations and cause the death of the T-lymphocytes. This the production of pro-inflammatory cytokines is reduced.
2. Anti-Integrin Therapy:
Integrin is a chemical molecule that helps in the adhesion and attraction of various pro-inflammatory cells like dendritic cells and lymphocytes. This molecule also helps in the immigration of the leukocytes in the intestinal mucosa. This chemical also plays a crucial role in the expression of the extra-intestinal symptoms of irritable bowel syndrome. Natalizumab and Vedolizumab are two anti-integrin used for the treatment of IBS. These drugs prevent migration and adhesion of the pro-inflammatory cells in the gastric lumen.
3. Anti-Cytokines Antibodies:
In irritable bowel syndrome, cytokines are produced by the T-helper cells, monocytes, and intestinal macrophages. These cytokines are the main mediators of inflammation. Interleukins are one of the major cytokines produced by this process. This helps in the maintenance of the T-helper cells and secretion of Interferon‐gamma (a cytokine that produces an immune response). Drugs like Ustekinumab reduce the secretion of interleukin by preventing its singling mechanisms.
4. Inhibitors of T-Cell Activation:
T-lymphocytes are one of the key cells responsible for inflammatory reactions in irritable bowel syndrome. Drugs like Priliximab acts as CD4-depleting antibody and prevent the activation of the T-lymphocytes. Visilizumab, an anti-CD3 antibody responsible for the death of the activated t lymphocytes.
Conclusion:
Irritable bowel syndrome is a type of chronic gut disorder. This is characterized by altered bowel movement, abdominal pain, and difficulty in digestion. The exact cause of this condition is not known. Several factors like anxiety, depression, and change in gut microbiota are associated with this condition. Over the years, several therapeutic options have been tried to cure this disorder. But controlling the inflammatory reactions associated with it seems difficult. Biological therapies help to reduce inflammatory reactions by controlling the production of chemicals and preventing cellular activity.
