Predisposing Psycho Concurrent Brain-gut factors Physiological modifiers dysregulation triggers Cortical Arousal Stress-response Prolonged threat neuromodulation (anxiety) &effortful copin ng CN NS ersonality, emotiona Support, age, ge enger Early life-+ Sleep dysfunction sensitin Life event stress Food allergens ntericinfection Altered bowel flora Inflammation trauma Post-infective lENs Altered Epithelial neuromodulation permeability Dysmotility GI svmptoms IBS EI symptomsPredisposing factors Psycho￾Physiological triggers Concurrent modifiers Brain-gut dysregulation Early life Enteric infection Inflammation, trauma ↓ Stress-response neuromodulation Post-infective neuromodulation Personality, emotional Support, age, gender, Sleep dysfunction Life event stress, Food allergens, Altered bowel flora ↑ Prolonged threat &effortful coping CNS ENS Cortical Arousal (anxiety)) Visceral hypersensitivity GI symptoms EI symptoms IBS Dysmotility Altered Epithelial permeability