A proof-of-concept study showing antibiotics to be more effective in irritable bowel syndrome with than without small-intestinal bacterial overgrowth

Ghoshal, Uday C; Srivastava, Deepakshi; Misra, Asha; Ghoshal, Ujjala

doi:10.1097/meg.0000000000000557

Cited by 63 publications

(77 citation statements)

References 29 publications

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“…We identified nine trials, reported in eight separate papers, [90][91][92][93][94][95][96][97] which evaluated antibiotic therapy in 2845 patients with IBS (Figure 6). Detailed trial characteristics are provided in Table 3.…”

Section: Efficacy and Safety Of Antibiotics In Ibsmentioning

confidence: 99%

Systematic review with meta‐analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome

Ford

Harris

Lacy

et al. 2018

Aliment Pharmacol Ther

464

339

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Summary Background Irritable bowel syndrome (IBS) is a chronic functional bowel disorder. Disturbances in the gastrointestinal microbiome may be involved in its aetiology. Aim To perform a systematic review and meta‐analysis to examine the efficacy of prebiotics, probiotics, synbiotics and antibiotics in IBS. Methods MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched (up to July 2017). Randomised controlled trials (RCTs) recruiting adults with IBS, comparing prebiotics, probiotics, synbiotics or antibiotics with placebo or no therapy were eligible. Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% confidence interval (CI). Continuous data were pooled using a standardised mean difference with a 95% CI. Results The search identified 4017 citations. Data for prebiotics and synbiotics were sparse. Fifty‐three RCTs of probiotics, involving 5545 patients, were eligible. Particular combinations of probiotics, or specific species and strains, appeared to have beneficial effects on global IBS symptoms and abdominal pain, but it was not possible to draw definitive conclusions about their efficacy. There were five trials of similar design that used rifaximin in non‐constipated IBS patients, which was more effective than placebo (RR of symptoms persisting = 0.84; 95% CI 0.79‐0.90). Adverse events were no more common with probiotics or antibiotics. Conclusions Which particular combination, species or strains of probiotics are effective for IBS remains, for the most part, unclear. Rifaximin has modest efficacy in improving symptoms in non‐constipated IBS.

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Section: Efficacy and Safety Of Antibiotics In Ibsmentioning

confidence: 99%

Systematic review with meta‐analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome

Ford

Harris

Lacy

et al. 2018

Aliment Pharmacol Ther

464

339

View full text Add to dashboard Cite

show abstract

“…A causative role of SIBO in IBS has been established by Koch's postulates 27 . Moreover, three recent studies, one from India, 28 one from China, 29 and the most recent one from USA, 30 showed that response of IBS patients with SIBO to treatment with antibiotics is far greater than when antibiotics are used without testing for SIBO. These studies suggest that in future, treatment of IBS patients may see a paradigm shift with a more personalized or individualized approach somewhat similar to several other fields of medicine.…”

Section: Gut Microbiota Dysbiosis In Irritable Bowel Syndromementioning

confidence: 99%

“…However, these may work through different mechanisms in different subtypes of IBS patients. For example, three studies showed that antibiotics are more often effective in patients with IBS‐D with SIBO than those without SIBO 28–30 . In patients with IBS‐C, rifaximin with or without neomycin works primarily by targeting methanogens, which, by producing methane, slow colon transit.…”

Section: Pathophysiology‐directed Treatment For Irritable Bowel Syndromementioning

confidence: 99%

Marshall and Warren Lecture 2019: A paradigm shift in pathophysiological basis of irritable bowel syndrome and its implication on treatment

Ghoshal

2020

J of Gastro and Hepatol

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Irritable bowel syndrome (IBS), a common functional gastrointestinal disorder (FGID), has often been considered rather inappropriately as psychogenic in the past. Though psychological issues are important comorbidities in a proportion of IBS patients, the evidences are far from enough to label this condition as psychogenic only. In the recent past, evidences are emerging that underscores the concept supporting pure psychogenic theory of IBS and suggest this disorder to be rather microorganic. Accordingly, a move of Rome IV Committee attempting to delete the term "functional" and designating these to be disorders of "gut-brain interaction" rather than that of "brain-gut interaction," it emphasizes the importance of the gut over the brain in the pathogenesis. The introduction of the concept of multidimensional clinical profile in Rome IV requires attention to diagnostic category of FGID, overlap, severity, psychological issues, and physiological dysfunction or biomarkers; this attempts to recognize clinical variability and multidimensionality of pathophysiology and management of these disorders. The recognition of the biological factors in the pathogenesis of IBS is a significant paradigm shift in the recent time. This is somewhat similar to the progress in the pathogenesis of peptic ulcer disease from psychological factor to acid to Helicobacter pylori infection. It is expected that in the near future, therapeutic modalities targeting the different pathogenic mechanisms of different subtypes of IBS may bring revolution in management of the disorder.

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“…Though in the past, tetracycline, doxycycline, co-trimoxazole, fluoroquinolones have all been used in the treatment of SIBO,109,110 in most of the recent studies among patients with IBS, rifaximin has been the preferred antibiotic (Table 2). 52,108,111–114…”

Section: Treatment Of Sibo In Patients With Ibsmentioning

confidence: 99%

Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy

2017

Self Cite

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The pathogenesis of irritable bowel syndrome (IBS), once thought to be largely psychogenic in origin, is now understood to be multifactorial. One of the reasons for this paradigm shift is the realization that gut dysbiosis, including small intestinal bacterial overgrowth (SIBO), causes IBS symptoms. Between 4% and 78% of patients with IBS and 1% and 40% of controls have SIBO; such wide variations in prevalence might result from population differences, IBS diagnostic criteria, and, most importantly, methods to diagnose SIBO. Although quantitative jejunal aspirate culture is considered the gold standard for the diagnosis of SIBO, noninvasive hydrogen breath tests have been popular. Although the glucose hydrogen breath test is highly specific, its sensitivity is low; in contrast, the early-peak criteria in the lactulose hydrogen breath test are highly nonspecific. Female gender, older age, diarrhea-predominant IBS, bloating and flatulence, proton pump inhibitor and narcotic intake, and low hemoglobin are associated with SIBO among IBS patients. Several therapeutic trials targeting gut microbes using antibiotics and probiotics have further demonstrated that not all symptoms in patients with IBS originate in the brain but rather in the gut, providing support for the micro-organic basis of IBS. A recent proof-of-concept study showing the high frequency of symptom improvement in patients with IBS with SIBO further supports this hypothesis.

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A proof-of-concept study showing antibiotics to be more effective in irritable bowel syndrome with than without small-intestinal bacterial overgrowth

Abstract: Norfloxacin is superior to placebo in relieving symptoms of SIBO-associated IBS.

Cited by 63 publications

References 29 publications

Systematic review with meta‐analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome

Systematic review with meta‐analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome

Marshall and Warren Lecture 2019: A paradigm shift in pathophysiological basis of irritable bowel syndrome and its implication on treatment

Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy

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