Serotonin (5‐hydroxytryptamine, 5‐HT) is an important mediator of every major gut‐related function. Recent investigations also suggest that 5‐HT can influence the development and severity of inflammation within the gut, particularly in the setting of inflammatory bowel disease (IBD).

To review the roles that the intestinal serotonin signalling system plays in gut function, with a specific focus on IBD.

We reviewed manuscripts from 1952 to 2017 that investigated and discussed roles for 5‐HT signalling in gastrointestinal function and IBD, as well as the influence of inflammation on 5‐HT signalling elements within the gut.

Inflammation appears to affect every major element of intestinal 5‐HT signalling, including 5‐HT synthesis, release, receptor expression and reuptake capacity. Importantly, many studies (most utilising animal models) also demonstrate that modulation of selective serotonergic receptors (via agonism of 5‐HT₄R and antagonism of 5‐HT₃R) or 5‐HT signal termination (via serotonin reuptake inhibitors) can alter the likelihood and severity of intestinal inflammation and/or its complicating symptoms. However, there are few human studies that have studied these relationships in a targeted manner.

Insights discussed in this review have strong potential to lead to new diagnostic and therapeutic tools to improve the management of IBD and other related disorders. Specifically, strategies that focus on modifying the activity of selective serotonin receptors and reuptake transporters in the gut could be effective for controlling disease activity and/or its associated symptoms. Further studies in humans are required, however, to more completely understand the pathophysiological mechanisms underlying the roles of 5‐HT in this setting.