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The underlying issues that can cause IBS include the following: Alterations to brain-gut connection Post-infectious reactions Low-grade gut inflammation Low-grade mucosal immune activation Changes and imbalances in the gut microbiome (the gut bacteria) Dysregulation of serotonin signalling Genetic factors When approaching IBS its important to understand the impact of smoking as well as vaping and e-cigarettes have on the gut and the gut microbiome