Targeting the Gut Microbiota in IBS

A deeper understanding of dysbiosis and IBS symptoms is contributing to the development of interventions that target the gut microbiome.12,13 These therapies include12,13:

icon of knife and fork crossed
Elimination diets

Diets that reduce or eliminate fermentable oligo-, di-, mono-saccharides and polyols (FODMAPs), wheat, or gluten may have an effect on IBS symptoms.33,34

  • Animal studies have shown that FODMAPs contribute to changes in gut microbiota, intestinal permeability, and fecal lipopolysaccharide levels that are associated with the development of visceral hypersensitivity.35
  • It is thought that gluten or wheat-related dietary components may alter barrier function, which may lead to inflammation, altered stool consistency, and visceral hypersensitivity.33
icon of probiotic
Prebiotics/Probiotics
  • Prebiotics are indigestible food or dietary supplements, such as fructo-oligosaccharides (FOS) and inulin, that may result in specific changes in the composition and/or activity of gut microbiota; however, research to date on the effectiveness of prebiotics in IBS remains inconclusive.36,37
  • Probiotics contain live or attenuated microorganisms, and studies suggest that some strains have anti-inflammatory properties and may help improve mucosal barrier function and modulate visceral hypersensitivity.23,36-39
icon of tablet and capsule
Pharmacologic Interventions
  • Pharmacologic treatments can target gut microbiota that may play a role in the pathogenesis of IBS symptoms.40,41
icon of capsule open spilling contents
Fecal microbiota transplantation
  • Some studies have shown improvements in IBS symptoms following fecal microbiota transplantation (FMT); however, unlike FMT in patients with Clostridioides difficile, the success of FMT in IBS and other conditions may be more donor dependent.42-44
MICROBIAL IMBALANCE IN IBD
 
IBS = irritable bowel syndrome
 
 

References

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  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.
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  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.
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  20. Luczynski P, Tramullas M, Viola M, et al. Microbiota regulates visceral pain in the mouse. Elife. 2017;6:e25887.
  21. O’Mahoney SM, Felice VD, Nally K, et al. Disturbance of the gut microbiota in early-life selectively affects visceral pain in adulthood without impacting cognitive or anxiety-related behaviors in male rats. Neuroscience. 2014;277:885-901.
  22. Crouzet L, Gaultier E, Del’Homme C, et al. The hypersensitivity to colonic distension of IBS patients can be transferred to rats through their fecal microbiota. Neurogastroenterol Motil. 2013;25(4):e272-e282.
  23. Verdu EF, Bercik P, Verma-Gandhu M, et al. Specific probiotic therapy attenuates antibiotic induced visceral hypersensitivity in mice. Gut. 2006;55(2):182-190.
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  40. Lembo A, Pimentel M, Rao SS, et al. Repeat treatment with rifaximin is safe and effective in patients with diarrhea-predominant irritable bowel syndrome. Gastroenterology. 2016;151(6):1113-1121.
  41. EnteraGam (serum-derived bovine immunoglobulin/protein isolate) [product information]. Ankeny, IA: Entera Health, Inc.; 2017.
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  43. Mizuno S, Masaoka T, Naganuma M, et al. Bifidobacterium-rich fecal donor may be a positive predictor for successful fecal microbiota transplantation in patients with irritable bowel syndrome. Digestion. 2017;96(1):29-38.
  44. Mazzawi T, Lied GA, Sangnes DA, et al. The kinetics of gut microbial community composition in patients with irritable bowel syndrome following fecal microbiota transplantation. PLoS One. 2018;13(11):e0194904.
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