A Precision Digestive Medicine Approach to Persistent Irritable Bowel Syndrome (IBS)

Understanding Persistent IBS

Irritable bowel syndrome (IBS) is one of the most commonly diagnosed gastrointestinal conditions, affecting approximately 7–15% of the global population.¹ Despite its prevalence, many individuals continue to experience fluctuating or persistent symptoms despite dietary modification, reassurance or medication.

While IBS has historically been classified as a functional gastrointestinal disorder, contemporary research recognises it as a disorder of gut–brain interaction with measurable biological correlates — including alterations in motility, microbial ecology, immune signalling and neuro-enteric communication.²

Persistent IBS is rarely arbitrary. It reflects identifiable physiological patterns.

IBS Is a Clinical Pattern — Not a Single Cause

IBS is defined by symptom-based criteria (Rome IV) rather than by mechanism.³ The diagnosis describes what is happening, but not necessarily why.

Current research supports multiple overlapping contributory drivers:

• Microbial imbalance within the gut microbiome⁴

• Small intestinal bacterial overgrowth⁵

• Post-infectious immune activation⁶

• Motility disturbance⁷

• Visceral hypersensitivity⁸

• Low-grade mucosal immune activation⁹

• Dysregulation of the gut–brain axis¹⁰

In many cases, IBS represents the cumulative expression of interacting biological processes rather than a single isolated dysfunction.

A precision framework seeks to clarify which mechanisms are clinically relevant in each individual presentation.

Why Symptoms Persist Despite “Normal” Testing

Standard investigations often exclude structural disease but may not evaluate:

• Functional motility disturbances

• Subtle microbial shifts

• Barrier integrity alterations

• Neuro-enteric signalling patterns

Research increasingly supports the role of microbiome-host interactions and neuro-immune modulation in IBS pathogenesis.¹¹

Persistent IBS does not imply absence of pathology — it often reflects mechanisms that require more nuanced evaluation.

The Precision Digestive Medicine Framework

Dr. Alain Frabotta applies a staged functional medicine model to persistent IBS presentations.

This approach is systematic, proportionate and clinically reasoned.

Phase 1 – Clinical Mapping

• Detailed history and symptom chronology

• Subtype identification and pattern recognition

• Assessment of dietary triggers and stress physiology

• Review of precipitating infection

IBS frequently develops following acute gastroenteritis (post-infectious IBS), with immune and microbial alterations persisting beyond the initial event.⁶

Phase 2 – Targeted Investigations

Where clinically indicated, selective testing may be used to clarify:

• Microbial composition patterns

• Food sensitivities

• Bacterial overgrowth

• Inflammatory markers

• Digestive function parameters

• Investigation is proportionate and hypothesis-driven — not routine or exploratory.

Phase 3 – Structured Intervention

Therapeutic strategies may include:

• Microbial modulation

• Motility support

• Targeted nutritional adjustments

• Anti-inflammatory approaches

• Gut–brain axis regulation

Evidence supports multimodal, mechanism-targeted strategies rather than reliance on single-modality treatment.¹²

Phase 4 – Stabilisation & Relapse Prevention

• Gradual dietary expansion where appropriate

• Regulation of stress physiology

• Long-term resilience planning

• Reduction of relapse risk

The objective is sustained digestive stability and physiological resilience — not short-term symptom suppression.

IBS and the Gut–Brain Axis

The gastrointestinal tract and central nervous system communicate bidirectionally through neural, endocrine and immune pathways.¹⁰

Psychological stress can:

• Alter intestinal permeability

• Influence microbial composition

• Increase visceral sensitivity

• Affect motility patterns

Addressing IBS may therefore require attention to both the enteric and the neuroregulatory systems.

When to Consider a Comprehensive Evaluation

You may benefit from a structured assessment if:

• IBS symptoms recur despite dietary modification

• Bloating remains persistent or disproportionate

• Symptoms began following the infection

• There is an incomplete response to medication

• Food sensitivities expand over time

• Digestive symptoms coexist with fatigue or systemic features

A Measured Clinical Approach

Precision Digestive Medicine does not rely on indiscriminate testing or aggressive protocols.

It applies proportionate investigation and structured therapeutic sequencing designed to clarify drivers and restore digestive integrity in a controlled and sustainable manner.