برچسب: IBS

FUNCTION OF THE GUT MICROBIOTA IN IBS

Irritable bowel syndrome (IBS) as a functional gastrointestinal disorder (FGID) is one of the most frequent disorders of gut-brain interaction (DGBI). IBS pathophysiology remains not completely understood, and this results in unsatisfactory management. For all these reasons, IBS represents a challenge not only for the general practitioner but also for the gastroenterologists. Nowadays, major advances have been achieved in the detection of microbiota changes and microbiota modulation in patients with IBS. Indeed, gut microbiota is able to shape the host innate and adaptive immune system through specific interactions between gut bacteria and mucosal immune cells. This relationship greatly contributes to immunological homeostasis. Recent data suggest that IBS pathophysiology includes changes in gastrointestinal motility, intestinal secretion, visceral hypersensitivity, mucosal immune activation, and intestinal permeability, all of which can be influenced by the gut microbiota. Longitudinal studies showing gut microbiota fluctuation over time and dietary habits have helped understand IBS microbial signatures, identifying metabolic pathway that may be responsible of symptoms development that can be targeted in future. Treatments influencing gut microbiota such as prebiotics, probiotics, and non-absorbable antibiotics have been shown to be safe and effective for the treatment of patients with IBS.

GUT MICROBIOTA MODULATION FOR IBS TREATMENT

Increasing evidence suggests a key role of microbial modification approaches, including diet, pre- and probiotics, poorly absorbable antibiotics, or FMT, in the management of patients with IBS.

 A low FODMAP diet should be recommended as a second-line diet for IBS, after a traditional dietary advice to eat small regular meals, avoid known trigger foods, and reduce alcohol and caffeine. In addition, novel trends in dietary advices should be investigated in terms of gut microbiota modifications, such as the recent evidence regarding the effectiveness of green kiwifruit for treating IBS-C, as also assessed by the European Food Safety Authority.

Moreover, it is recently suggested that probiotics may be an effective treatment for global symptoms and abdominal pain in IBS, although a specific species or strain could not be recommend.

Several metagenomic analyses reported an increase in Bifidobacterium, Faecalibacterium prausnitzii, and Lactobacillus abundance after rifaximin treatment. Therefore, rifaximin can be defined as a “eubiotic”, i.e., a positive modulator of the gut ecosystem.

FMT, the process of transferring intestinal microbiota from a healthy donor into the gastrointestinal tract of a patient with dysbiosis, has been suggested and evaluated in IBS as well.

prepared by: Nazila Kassaian

References

Buono JL, Carson RT, Flores NM. Health-related quality of life, work productivity, and indirect costs among patients with irritable bowel syndrome with diarrhea. Health Qual Life Outcomes ۲۰۱۷; ۱۵:۳۵.

Vasant DH, Paine PA, Black CJ, et al. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut۲۰۲۱; ۷۰:۱۲۱۴-۴۰.

Marasco G, Cremon C, Barbaro MR, Stanghellini V, Barbara G. Gut microbiota signatures and modulation in irritable bowel syndrome. Microbiome Research Reports. 2022 Mar 5; 1(2):11.