PARs for the course: roles of proteases and PAR receptors in subtly inflamed irritable bowel syndrome.

Although the etiology of irritable bowel syndrome (IBS) remains unknown, clinical and laboratory observations suggest that within the broad and varying phenotype, that is, IBS, there may exist subgroups, which can be defined on the basis of a distinctive pathophysiological basis. Of these, postinfectious IBS is the best characterized; in IBS, in general, studies of inflammatory mediators and substances elaborated by cells involved in the intestinal immune response, such as proteases, suggest that some IBS sufferers can be differentiated on the basis of an aberrant immune response. Valdez-Morales and colleagues extend this concept by demonstrating the ability of supernatants of biopsy cultures from individuals with diarrhea-predominant IBS to enhance neuronal excitability-an effect that could well contribute to a clinical hallmark of IBS, namely, visceral hypersensitivity.