Attention in irritable bowel syndrome: A systematic review of affected domains and brain-gut axis interactions

Background

Irritable bowel syndrome (IBS) is a disorder characterized by gut–brain interactions, leading to abdominal pain and altered stool patterns, which significantly affect patients' quality of life. Recent research suggests that attention may be impaired in individuals with IBS, potentially influencing symptom perception and emotional distress.

Objective

This systematic review aims to examine the relationship between attention and IBS, focusing on the affected domains of attention and the interactions within the brain-gut axis.

Methods

A comprehensive search was conducted across MEDLINE/PubMed, PsychINFO, and Scopus from January 1990 to December 2024. Studies included were those that assessed attention in adult IBS patients using valid measurement tools. A total of 24 studies were analyzed, incorporating neuroimaging and behavioral methods.

Results

IBS individuals exhibit specific attentional impairments, including deficits in sustained attention, selective attentional biases toward gastrointestinal (GI)-related and symptom-specific stimuli, and heightened vigilance to threat and pain cues. Neurofunctional studies reveal altered brain activity in areas such as the insula, anterior cingulate cortex, and amygdala, indicating increased interoceptive awareness and cognitive load. Pre-attentive processing and sensory gating show exaggerated responses, while sustained attention and attentional control demand additional cognitive resources. These patterns reflect an interplay between heightened sensitivity to internal stimuli and cognitive processing challenges in IBS.

Conclusion

This review highlights specific attentional deficits and biases in IBS, suggesting they may contribute to symptom exacerbation and emotional distress. Further research is needed to explore the underlying mechanisms and potential therapeutic interventions.