Change in Composition

Microbial Composition Analysis

Stool samples from patients with IBS have shown distinct differences in quality, quantity, and temporal stability compared with healthy individuals.3,14-17

Bacterial overgrowth and reduced bacterial diversity have been observed in cultures from the small intestine of patients with IBS compared with healthy individuals.9,10,18

In one study, small intestinal bacterial overgrowth was more commonly associated with IBS-D compared with other subtypes.18

Important note: Studies of microbial composition have been limited to small populations and often restricted to one geographic region.10,15-17 Results therefore may not be extrapolated to all patients with IBS. No specific bacterial species has been consistently linked to IBS, including IBS-D, but the body of evidence is growing.10,17,19

History of Food Poisoning

Research has uncovered a link between IBS and infectious enteritis.1 In a meta-analysis of 45 studies, 1 in nine individuals exposed to foodborne pathogens developed IBS, a rate nearly four times greater than those who were not exposed. The most common subtypes associated with infectious enteritis were IBS-M (mixed) and IBS-D (diarrhea-predominant). Risk factors included2:

  • Female sex
  • Clinically severe infectious enteritis
  • Antibiotic use to treat infection
  • Psychological stress during infection

The mechanism by which previous GI infection results in IBS is still being explored. Animal models suggest that acute gastroenteritis has long-term effects on the immune system and GI motility, leading to alterations in gut microbial composition and post-infectious IBS.11

vertical bar graph prevalence of dysbiosis in healthy people, patients with IBS-D, patients with IBS-C, patients with IBS-M

Adapted, with permission, from: Casén C, Vebø HC, Sekelja M, et al. Deviations in human gut microbiota: a novel diagnostic test for determining dysbiosis in patients with IBS or IBD. Aliment Pharmacol Ther. 2015;42(1):71-83.

vertical bar graph quantity of e. coli in patients with IBS-D compared with patients with constipating or alternating I-BS

Adapted, with permission, from: Giamarellos-Bouboulis E, Tang J, Pyleris E, et al. Molecular assessment of differences in duodenal microbiome in subjects with irritable bowel syndrome. Scand J Gastroenterol. 2015;50(9):1076-1087.

MICROBIAL IMBALANCE AND IBS SYMPTOMS >>
IBS = irritable bowel syndrome.
IBS-D = irritable bowel syndrome with diarrhea.
IBS-M = irritable bowel syndrome with mixed bowel habits.
GI = gastrointestinal.
 
 

References

  1. Ringel Y. The gut microbiome in irritable bowel syndrome and other functional bowel disorders. Gastroenterol Clin North Am. 2017;46(1):91-101.
  2. Klem F, Wadhwa A, Prokop LJ, et al. Prevalence, risk factors, and outcomes of irritable bowel syndrome after infectious enteritis: a systematic review and meta-analysis. Gastroenterology. 2017;152(5):1042-1054.
  3. DuPont HL. Review article: evidence for the role of gut microbiota in irritable bowel syndrome and its potential influence on therapeutic targets. Aliment Pharmacol Ther. 2014;39(10):1033-1042.
  4. Lee KN, Lee OY. Intestinal microbiota in pathophysiology and management of irritable bowel syndrome. World J Gastroenterol. 2014;20(27):8886-8897.
  5. Zhuang X, Xiong L, Li L, Li M, Chen M. Alterations of gut microbiota in patients with irritable bowel syndrome: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2017;32(1):28-38.
  6. Passos MDCF, Moraes-Filho JP. Intestinal microbiota in digestive diseases. Arq Gastroenterol. 2017;54(3):255-262.
  7. Ghoshal UC, Shukla R, Ghoshal U, Gwee KA, Ng SC, Quigley EM. The gut microbiota and irritable bowel syndrome: friend or foe? Int J Inflam. 2012;2012:151085.
  8. Stern EK, Brenner DM. Gut microbiota-based therapies for irritable bowel syndrome. Clin Transl Gastroenterol. 2018;9(2):e-134.
  9. Posserud I, Stotzer PO, Björnsson ES, Abrahamsson H, Simrén M. Small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Gut. 2007;56(6):802-808.
  10. Giamarellos-Bouboulis E, Tang J, Pyleris E, et al. Molecular assessment of differences in duodenal microbiome in subjects with irritable bowel syndrome. Scand J Gastroenterol. 2015;50(9):1076-1087.
  11. Pimentel M, Morales W, Pokkunuri V et al. Autoimmunity links vinculin to the pathophysiology of chronic functional bowel changes following campylobacter jejuni infection in a rat model. Dig Dis Sci. 2015;60:1195-1205.
  12. Menees S, Chey W. The gut microbiome and irritable bowel syndrome. F1000Res. 2018;7(F1000 Faculty Rev):1029.
  13. Harris LA, Baffy N. Modulation of the gut microbiota: a focus on treatments for irritable bowel syndrome. Postgrad Med. 2017;129(8):872-888.
  14. Kassinen A, Krogius-Kurikka L, Mäkivuokko H, et al. The fecal microbiota of irritable bowel syndrome patients differs significantly from that of healthy subjects. Gastroenterology. 2007;133(1):24-33.
  15. Carroll IM, Ringel-Kulka T, Keku TO, et al. Molecular analysis of the luminal- and mucosal-associated intestinal microbiota in diarrhea-predominant irritable bowel syndrome. Am J Physiol Gastrointest Liver Physiol. 2011;301(5):G799-G807.
  16. Carroll IM, Ringel-Kulka T, Siddle JP, Ringel Y. Alterations in composition and diversity of the intestinal microbiota in patients with diarrhea-predominant irritable bowel syndrome. Neurogastroenterol Motil. 2012;24(6):521-530.
  17. Tap J, Derrien M, Törnblom H, et al. Identification of an intestinal microbiota signature associated with severity of irritable bowel syndrome. Gastroenterology. 2017;152(1):111-123.
  18. Pyleris E, Giamarellos-Bourboulis EJ, Tzivras D, Koussoulas V, Barbatzas C, Pimentel M. The prevalence of overgrowth by aerobic bacteria in the small intestine by small bowel culture: relationship with irritable bowel syndrome. Dig Dis Sci. 2012;57(5):1321-1329.
  19. König J, Brummer RJ. Alteration of the intestinal microbiota as a cause of and a potential therapeutic option in irritable bowel syndrome. Benef Microbes. 2014;5(3):247-261.
  20. Raskov H, Burcharth J, Pommergaard HC, Rosenberg J. Irritable bowel syndrome, the microbiota and the gut-brain axis. Gut Microbes. 2016;7(5):365-383.
  21. Ohkusa T, Koldo S, Nishikawa Y, Sato N. Gut microbiota and chronic constipation: A review and update. Front Med. 2019;6(19): doi: 10.3389/fmed.2019.00019.
  22. Distrutti E, Monaldi L, Ricci P, Fiorucci S. Gut microbiota role in irritable bowel syndrome: new therapeutic strategies. World J Gastroenterol. 2016;22(7):2219-2241.
  23. Kennedy PJ, Cryan JF, Dinan TG, Clarke G. Irritable bowel syndrome: a microbiome-gut-brain axis disorder? World J Gastroenterol. 2014;20(39):14105-14125.
  24. Quigley EMM. Gut bacteria in health and disease. Gastroenterol Hepatol. 2013;9(9):560-569.
  25. Fan WT, Ding C, Xu NN, Zong S, Ma P, Gu B. Close association between intestinal microbiota and irritable bowel syndrome. Eur J Clin Microbiol Infect Dis. 2017;36(12):2303-2317.
  26. Mayer EA, Tillisch K, Gupta A. Gut/brain axis and the microbiota. J Clin Invest. 2015;125(3):926-938.
  27. Quigley EMM. The gut-brain axis and the microbiome: clues to pathophysiology and opportunities for novel management strategies in irritable bowel syndrome (IBS). J Clin Med. 2018;7(1). doi:10.3390/jcm7010006.
  28. Skonieczna-Zydecka K, Marlicz W, Misera A, Koulaouzidis A, Loniewski I. Microbiome – the missing link in the gut-brain axis: focus on its role in gastrointestinal and mental health. J Clin Med. 2018;7(12). doi:10.3390/jcm7120521.
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