181 Striking Prevalence of Irritable Bowel Syndrome in Former Prisoners of War: Analysis of Risk Factors

Pulling, Michele C.; Orsborn, Mack; Olson, Barbara J.; Hunt, Stephen; Kearney, David J.

doi:10.1016/s0016-5085(08)60151-1

Cited by 1 publication

(2 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In contrast to the lack of dose-response data between SIBO and IBS, data indicate that other purported risk factors for IBS, such as psychological trauma, reliably predict developing IBS in a dose-response manner. 59,[62][63][64][65] Is There Consistency Among Studies Linking SIBO and IBS?…”

Section: Is There a Dose-response Effect Between Sibo And Ibs?mentioning

confidence: 99%

“…In the context of the "brain-gut" theory of IBS, the model could explain how the visceral anxiety of IBS might trigger "gut feelings" in the midst of a threat, leading the host to either fight or flee. 93 Over thousands of generations, this small advantage could provide a survival benefit, and might even explain why soldiers develop gastrointestinal distress in the midst of extraordinarily stressful combat, [45][46][47]62,63 or why residents in Nicaragua developed longstanding gastrointestinal distress after exposure to the brutality of the Sandanista revolution. 64,65 For most modern patients, there are no physical threats in their immediate environmentno actual combat, or lions lurking in wait.…”

Section: Sibo and Ibs: An Evolutionary Perspectivementioning

confidence: 99%

See 1 more Smart Citation

Questioning the Bacterial Overgrowth Hypothesis of Irritable Bowel Syndrome: An Epidemiologic and Evolutionary Perspective

Spiegel

2011

Clinical Gastroenterology and Hepatology

View full text Add to dashboard Cite

Although studies indicate that small intestinal bacterial overgrowth (SIBO) is prevalent in irritable bowel syndrome (IBS), it remains unclear whether SIBO causes IBS. This review presents an epidemiologic and evolutionary inquiry that questions the bacterial overgrowth hypothesis of IBS, as follows. (1) Although the hypothesis may be biologically plausible, there is also a strong rationale for competing hypotheses; it is unlikely that SIBO is the predominant cause of IBS in all comers, because competing explanations are sensible and defensible. Moreover, data indicate that the test used to promulgate the SIBO hypothesis - the lactulose hydrogen breath test - may not have measured SIBO in the first place. (2) We do not have evidence of SIBO being absent before IBS symptoms, and present after IBS emerges. (3) There is not a dose-response relationship between small intestinal microbiota and IBS symptoms. (4) The relationship between SIBO and IBS is highly inconsistent among studies. (5) Many effective IBS therapies do not address SIBO at all, yet have a more favorable "number needed to treat" than antibiotics. (6) IBS does not behave like a traditional infectious disease, suggesting that microbes may not principally cause the syndrome. (7) Other factors may confound the relationship between SIBO and IBS, including proton pump inhibitors. (8) Whereas the brain-gut hypothesis is evolutionary sensible, the bacterial hypothesis is harder to defend from an evolutionary perspective. The article concludes that bacteria may contribute to some IBS symptoms, but that bacteria cannot be the only explanation, and a causal link between SIBO and IBS is not secure.

show abstract