Irritable bowel syndrome: an avenue for therapeutic restoration of peripheral nerve imbalance

The bowel is a tightly regulated and controlled system that can easily be disrupted by changes in the intestinal microbiome, neurotransmitters, motility or ion balance. Despite numerous proposed pathophysiological mechanisms, much remains unknown regarding irritable bowel syndrome (IBS). In particular, there is a scarcity of research describing IBS secondary to peripheral nerve dysfunction outside of diabetic populations. Recent research surrounding the mesentery has redefined our understanding of the bowel microenvironment. The function of the mesentery in bowel pathology is a novel area of interest and has potential as a pharmacological target. Serotonin is a key neurotransmitter in the interaction between mesentery and bowel, with serotonergic neurons comprising 2% of the mesenteric neurons. This relationship makes serotonin a potential target to regulate bowel functioning among IBS patients. This article outlines a case of treatment-resistant IBS that was effectively managed by targeting an underlying peripheral neuropathy. This case highlights the link between peripheral nerve dysfunction and IBS. It also outlines a potential avenue of therapeutic management for those with refractory symptoms.