Plain language summary
Irritable bowel syndrome (IBS) is a common functional gut disorder characterised by abdominal pain and associated changes in bowel habits. Increasing evidence points to altered gut microbiota, dysbiosis, as a predominant factor in IBS development and has therefore become a primary target for therapeutic options in patients with IBS. This review evaluates existing literature on IBS interventions targeting the gut microbiota and suggests future approaches useful for diagnosis, prevention and treatment of IBS. Based on the current literature, this review suggests there is a strong role of dysbiosis in the pathophysiology of IBS. The authors conclude that there are promising therapeutic options available but further evidence is needed from larger controlled studies.
Abstract
Irritable bowel syndrome (IBS), one of the most frequent digestive disorders, is characterized by chronic and recurrent abdominal pain and altered bowel habit. The origin seems to be multifactorial and is still not well defined for the different subtypes. Genetic, epigenetic and sex-related modifications of the functioning of the nervous and immune-endocrine supersystems and regulation of brain-gut physiology and bile acid production and absorption are certainly involved. Acquired predisposition may act in conjunction with infectious, toxic, dietary and life event-related factors to enhance epithelial permeability and elicit mucosal microinflammation, immune activation and dysbiosis. Notably, strong evidence supports the role of bacterial, viral and parasitic infections in triggering IBS, and targeting microbiota seems promising in view of the positive response to microbiota-related therapies in some patients. However, the lack of highly predictive diagnostic biomarkers and the complexity and heterogeneity of IBS patients make management difficult and unsatisfactory in many cases, reducing patient health-related quality of life and increasing the sanitary burden. This article reviews specific alterations and interventions targeting the gut microbiota in IBS, including prebiotics, probiotics, synbiotics, non-absorbable antibiotics, diets, fecal transplantation and other potential future approaches useful for the diagnosis, prevention and treatment of IBS.
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