Advances in the management of irritable bowel syndrome: a systematic review of dietary and pharmacological strategies

Abstract Irritable bowel syndrome (IBS) is a functional disorder characterized by abdominal pain, bloating, and alterations in intestinal transit. Its pathophysiology involves interactions between the gut-brain axis, dysbiosis, and immune dysfunction. Therapeutic strategies have evolved in recent years, highlighting personalized approaches according to the predominant subtype. The low FODMAP diet has shown efficacy in reducing symptoms, while probiotics can modulate the intestinal microbiota, improving low-grade inflammation. Among pharmacological treatments, 5-HT4 agonists have shown efficacy in IBS with constipation, while rifaximin has shown good results in patients with diarrhea predominance. The use of neuromodulators such as amitriptyline is useful in patients with visceral hypersensitivity. However, the heterogeneity in clinical response suggests that treatment should be individualized. This review emphasizes the importance of a comprehensive approach and highlights the need for studies comparing therapeutic combinations to improve patients' quality of life. Keywords: Irritable bowel syndrome, microbiota, FODMAPs, probiotics, pharmacological therapy.