Introduction Irritable bowel syndrome (IBS) is a disorder that can be diagnosed positively on the basis of symptom criteria and evaluation to exclude organic diseases.1Camilleri M, Heading R C & Thompson W G. Consensus report: clinical perspectives, mechanisms, diagnosis and management of irritable bowel syndrome. Aliment Pharmacol Ther. 2002; 16: 1407-1430. Irritable bowel syndrome is among the most commonly encountered chronic functional gastrointestinal (GI) disorders afflicting individuals. Based on the Rome-III criteria abdominal pain accompanied by sustained changes in bowel habit constitute IBS, whose diagnosis is achieved in the absence of biochemical markers of disease. Clinical presentation of constipation, diarrhoea or a combination, constitutes the different subtypes of IBS: IBS with Constipation (IBS-C), IBS with Diarrhoea (IBS-D), Mixed IBS (IBS-M), Post infectious IBS (Pi-IBS), respectively.2Beatty K J, Bhargava A, Buret A G. Post-infectious irritable bowel syndrome: Mechanistic insights into chronic disturbances following enteric infection. World J Gastroenterol. 2014 April; 20(14):…
Non-alcoholic fatty liver disease (NAFLD) is universally considered as the hepatic manifestation of the metabolic syndrome.1Yilmaz Y. Review article: is non-alcoholic fatty liver disease a spectrum, or are steatosis and non-alcoholic steatohepatitis distinct conditions? Aliment Pharmacol Ther 2012; 36: 815-23. It is most commonly associated with insulin resistance/type 2 diabetes mellitus and obesity; and manifested by steatosis, steatohepatitis, cirrhosis, and rarely, hepatocellular carcinoma.2Tolman KG. Dalpiaz AS. Treatment of non-alcoholic fatty liver disease. Therapeutics and Clinical Risk Management 2007:3(6) 1153-63. 'Multiple-hit' Pathogenesis of NAFLD NAFLD is currently conceptualised as a clinical spectrum that results from a 'multiple-hit' process which begins with simple steatosis (first hit) and may progresses, more serious liver injuries like non-alcoholic steatohepatitis (NASH) and subsequently cirrhosis may develop (second hit). As depicted in figure 1, the initial or first hit is insulin resistance leading to an increased uptake and synthesis of free fatty acids resulting in simple fatty…
