Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2020; 26(13): 1427-1438
Published online Apr 7, 2020. doi: 10.3748/wjg.v26.i13.1427
Possible role of intestinal stem cells in the pathophysiology of irritable bowel syndrome
Magdy El-Salhy
Magdy El-Salhy, Section for Gastroenterology, Department of Medicine, Stord Hospital, Stord 54 09, Norway
Magdy El-Salhy, Department of Clinical Medicine, University of Bergen, Bergen 50 21, Norway
Author contributions: El-Salhy M wrote, conceived and edited this aricle.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Magdy El-Salhy, BSc, MA, MD, PhD, Chief Doctor, Professor, Consultant Gastroenterologist, Section for Gastroenterology, Department of Medicine, Stord Hospital, Box 4000, Stord 54 09, Norway. magdy.el-salhy@helse-fonna.no
Received: December 3, 2019
Peer-review started: December 3, 2019
First decision: January 13, 2020
Revised: February 8, 2020
Accepted: March 14, 2020
Article in press: March 14, 2020
Published online: April 7, 2020
Processing time: 125 Days and 21.4 Hours
Abstract

The pathophysiology of irritable bowel syndrome (IBS) is not completely understood. However, several factors are known to play a role in pathophysiology of IBS such as genetics, diet, gut microbiota, gut endocrine cells, stress and low-grade inflammation. Understanding the pathophysiology of IBS may open the way for new treatment approaches. Low density of intestinal stem cells and low differentiation toward enteroendocrine cells has been reported recently in patients with IBS. These abnormalities are believed to be the cause of the low density of enteroendocrine cells seen in patients with IBS. Enteroendocrine cells regulate gastrointestinal motility, secretion, absorption and visceral sensitivity. Gastrointestinal dysmotility, abnormal absorption/secretion and visceral hypersensitivity are all seen in patients with IBS and haven been attributed to the low density the intestinal enteroendocrine cells in these patients. The present review conducted a literature search in Medline (PubMed) covering the last ten years until November 2019, where articles in English were included. Articles about the intestinal stem cells and their possible role in the pathophysiology of IBS are discussed in the present review. The present review discusses the assumption that intestinal stem cells play a central role in the pathophysiology of IBS and that the other factors known to contribute to the pathophysiology of IBS such as genetics, diet gut microbiota, stress, and low-grade inflammation exert their effects through affecting the intestinal stem cells. It reports further the data that support this assumption on genetics, diet, gut microbiota, stress with depletion of glutamine, and inflammation.

Keywords: Diet; Gut enteroendocrine cells; Gut microbiota; Low grade inflammation; Stress

Core tip: The pathophysiology of irritable bowel syndrome (IBS) is not completely understood. Understanding the pathophysiology of IBS may enable us to find an effective treatment for this disorder. The density of intestinal stem cells is low in patients with IBS. Moreover, the differentiation of stem cells into enteroendocrine cells is abnormal. It seems that these abnormalities in intestinal stem cells is the cause of the low density of enteroendocrine cells seen in patients with IBS. It is believed that the low density of enteroendocrine cells is behind the gastrointestinal dysmotility, abnormal secretion/absorption and hypersensitivity observed in patients with IBS. This review presents the observations that suggest that the factors known to contribute to the pathophysiology of IBS may exert their effects through affecting the intestinal stem cells.