Modulation of the gut microbiota: a focus on treatments for irritable bowel syndrome

Abstract

Irritable bowel syndrome (IBS), which is characterized by recurrent abdominal pain and disordered bowel habits, is one of the most common functional bowel disorders. IBS is a substantial burden on both patient health-related quality of life and healthcare costs. Several pathophysiologic mechanisms have been postulated for the occurrence of IBS, including altered gastrointestinal motility, visceral hypersensitivity, changes in gut permeability, immune activation, gut-brain dysregulation, central nervous system dysfunction, and changes in the gut microbiota. Of note, both qualitative and quantitative differences have been observed in the gut microbiota of a population with IBS versus a healthy population. Because of the substantial interest in the gut microbiota and its role as a therapeutic target in IBS, this article provides an overview of specific interventions with the potential to modulate the gut microbiota in IBS, including elimination diets, prebiotics, probiotics, synbiotics, and nonsystemic antibiotics. Although probiotics and synbiotics are generally well tolerated, differences in the composition and concentration of different bacterial species and inclusion or exclusion of prebiotic components varies widely across studies and has prevented strong recommendations on their use in IBS. For nonsystemic antibiotics, rifaximin is indicated in the United States for the treatment of IBS with diarrhea in adults and has been shown to be efficacious and well tolerated in well-designed clinical trials. Overall, more consistent evidence is needed regarding the efficacy and safety of elimination diets, prebiotics, probiotics, and synbiotics for the treatment of patients with IBS. Furthermore, additional well-designed studies are needed that examine alterations in the gut microbiota that occur with these interventions and their potential associations with clinical symptoms of IBS. ARTICLE HISTORY

Risk of psychiatric disorders in irritable bowel syndrome-A nationwide, population-based, cohort study

“…The effects of antidepressants, anxiolytics, and even antipsychotics in the treatment of IBS also hint at the correlations between IBS and psychiatric disorders. The recent development of probiotics also found that gut flora could play a role in the development and management of IBS …”

Duodenal and rectal mucosal microbiota related to small intestinal bacterial overgrowth in diarrhea‐predominant irritable bowel syndrome

“…The etiology for irritable gut should be multifactorial and heterogenous, and no consistent biomarker or unifying framework has been available to explain the diverse symptoms and findings in IBS . Recently, gut dysbiosis has been proposed as a player in IBS . Variations of microbial composition, function and metabolism have been demonstrated in IBS, particularly those with a diarrhea‐predominant subtype …”

“…Recently, gut dysbiosis has been proposed as a player in IBS . Variations of microbial composition, function and metabolism have been demonstrated in IBS, particularly those with a diarrhea‐predominant subtype …”

Deep-Fried Atractylodis Rhizoma Protects against Spleen Deficiency-Induced Diarrhea through Regulating Intestinal Inflammatory Response and Gut Microbiota

“…Recently, the gut microbiota has been recognized to be critical in influencing the in vivo therapeutic effects of herbal medicines [47,48]. Gut microbiota analysis with 16S rDNA amplification sequencing revealed significant differences in the overall structure of the gut microbiota between different experimental groups, especially in rats of the model group compared with those in the control group.…”