Irritable bowel syndrome (IBS) is a common disorder of gut–brain interaction characterised by symptoms of abdominal pain, occurring at least 1 day per week, and a change in stool frequency or form. Individuals with IBS are usually subtyped according to their predominant bowel habit, which is used to direct symptom-based treatment. However, this approach is probably an oversimplification of a complex and multidimensional condition, and other factors, such as psychological health, are known to influence symptom severity and prognosis. We have previously used latent class analysis, a method of mathematical modelling, to show that people with IBS can be classified into seven unique clusters based on a combination of gastrointestinal symptoms, abdominal pain, extraintestinal symptoms, and psychological comorbidity. The clusters can be used to predict the prognosis of IBS (eg, symptom severity), health-care use (eg, consultation behaviour, prescribing, and costs), and impact (eg, quality of life, work and productivity, activities of daily living, and income). These clusters could also be used to increase the personalisation of IBS treatment that better recognises the heterogenous nature of the condition. We present new data providing additional validation of our seven-cluster model and conduct a comprehensive evidence-based review of IBS management. Based on this evidence, we propose a framework of first-line and second-line treatments according to IBS cluster. Finally, we discuss what further research is needed to implement this approach in clinical practice, including the need for randomised trials comparing cluster-based treatment with conventional treatment according to stool subtype.

中文翻译：

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肠易激综合征的个体化治疗：一个假设


肠易激综合征 （IBS） 是一种常见的肠脑相互作用疾病，其特征是腹痛症状，每周至少发生 1 天，以及大便频率或形式的变化。IBS 患者通常根据其主要排便习惯进行亚型分析，用于指导基于症状的治疗。然而，这种方法可能是对复杂和多维疾病的过度简化，并且已知其他因素（例如心理健康）会影响症状的严重程度和预后。我们之前使用潜在类别分析（一种数学建模方法）来表明，根据胃肠道症状、腹痛、肠外症状和心理合并症的组合，IBS 患者可以分为七个独特的集群。这些集群可用于预测 IBS 的预后（例如，症状的严重程度）、医疗保健使用（例如，咨询行为、处方和费用）和影响（例如，生活质量、工作和生产力、日常生活活动和收入）。这些集群也可用于增加 IBS 治疗的个性化，从而更好地识别病情的异质性。我们提供了新数据，为我们的七集群模型提供了额外的验证，并对 IBS 管理进行了全面的循证审查。基于这些证据，我们根据 IBS 集群提出了一线和二线治疗的框架。最后，我们讨论了在临床实践中实施这种方法需要哪些进一步的研究，包括需要根据粪便亚型比较基于整群治疗的随机试验与常规治疗。