Irritable bowel syndrome pharmacotherapy: risk stratification, real-world validation, and treatment sequencing pathways

Background and rationaleIrritable bowel syndrome (IBS), a core disorder of gut–brain interaction, remains one of the most common and heterogeneous conditions encountered in gastroenterology. While multiple pharmacological options exist—spanning gut-directed agents, neuromodulators, and emerging mechanism-based therapies—clinical decision-making is often limited by variable treatment response, frequent comorbidities (e.g., anxiety/depression, functional dyspepsia), safety/tolerability trade-offs, and gaps between randomized trial efficacy and day-to-day effectiveness. At the same time, increasing availability of real-world datasets (registries, claims, EHRs, pragmatic trials, and patient-reported outcomes) and evolving clinical pathways create an opportunity to validate risk stratification approaches and optimize sequencing strategies that are feasible in routine care.This Research Topic focuses on pharmacotherapy as a pathway problem: who benefits from what, when, and in which order—grounded in risk stratification, real-world validation, and treatment sequencing pathways. We aim to bring together clinicians, trialists, pharmacoepidemiologists, and translational researchers to advance practical, evidence-based algorithms that can improve outcomes, reduce trial-and-error prescribing, and support guideline implementation across diverse patient populations.Scope and themesWe welcome contributions addressing (but not limited to):Risk stratification frameworks for IBS pharmacotherapy (clinical phenotypes, IBS subtypes, symptom clusters, comorbidity patterns)Biomarker-, microbiome-, or pharmacogenomic-informed treatment selection (including validation and limitations)Real-world evidence on effectiveness, safety, persistence/adherence, and comparative outcomes across therapiesPragmatic trials and hybrid effectiveness–implementation studies in IBS pharmacotherapyTreatment sequencing strategies (step-up/step-down approaches, switching rules, combination strategies, rescue pathways)Decision-support tools and pathway integration in real-world workflows (primary care vs specialist settings)Outcomes that matter in practice: patient-reported outcomes, quality of life, work productivity, healthcare utilization, and equity/generalizabilityArticle typesWe welcome a range of contributions (depending on the journal’s permitted article types), including Original Research, Reviews (including systematic reviews/meta-analyses), Brief Research Reports, and Perspectives—especially work that translates evidence into actionable clinical pathways, and studies that explicitly test generalizability in real-world settings. Topic editors: Renitta Jobby, Anas Islam Source: https://www.frontiersin.org/research-topics/77989/irritable-bowel-syndrome-pharmacotherapy-risk-stratification-real-world-validation-and-treatment-sequencing-pathways