Bugs and Irritable Bowel Syndrome: The Good, the Bad and the Ugly
Uday C Ghoshal ; Hyojin Park; Kok-Ann Gwee
Uday C Ghoshal ; Hyojin Park; Kok-Ann Gwee
Abstract
Recently, there has been strong interest in the therapeutic potential of probiotics for irritable bowel syndrome (IBS). At the same time, there is a rapidly growing body of evidence to support an etiological role for gastrointestinal infection and the associated immune activation in the development of post-infectious IBS. In a more controversial area, small intestinal bacterial overgrowth has been associated with a subset of patients with IBS; the issue of whether it is appropriate to treat a subset of IBS patients with antibiotics and probiotics is currently a matter for debate. Thus, it appears that the gastrointestinal microbial flora may exert beneficial effects for symptoms of IBS under some circumstances, while in other situations gut microbes could give rise to symptoms of IBS. How do we make sense of the apparently diverse roles that 'bugs' may play in IBS? To address this question, we have conducted an in-depth review, attempting where possible to draw lessons from Asian studies.
Recently, there has been strong interest in the therapeutic potential of probiotics for irritable bowel syndrome (IBS). At the same time, there is a rapidly growing body of evidence to support an etiological role for gastrointestinal infection and the associated immune activation in the development of post-infectious IBS. In a more controversial area, small intestinal bacterial overgrowth has been associated with a subset of patients with IBS; the issue of whether it is appropriate to treat a subset of IBS patients with antibiotics and probiotics is currently a matter for debate. Thus, it appears that the gastrointestinal microbial flora may exert beneficial effects for symptoms of IBS under some circumstances, while in other situations gut microbes could give rise to symptoms of IBS. How do we make sense of the apparently diverse roles that 'bugs' may play in IBS? To address this question, we have conducted an in-depth review, attempting where possible to draw lessons from Asian studies.
Introduction
The gut contains a vast and complex microbial ecosystem, comprising mainly bacteria, of which most are strict anaerobes; it also includes fungi and viruses.[1,2] The human gastrointestinal (GI) tract contains more than 500 1000 species of bacteria.[3] The bacterial population increases in number and diversity in the more distal parts of the gut; human large intestine contains as many as 10[11 12] organisms per gram of fecal material. [4] Recently, there has been increased interest in the role of qualitative and quantitative changes in gut flora in health and in GI diseases. Irritable bowel syndrome (IBS), a common gastrointestinal disorder of unknown pathogenesis, is one such condition which might be related to changes in the gut flora.
Recent published reports on post -infectious IBS (PI-IBS),[5] small intestinal bacterial overgrowth (SIBO) in IBS, [6] relationships between the gut flora and sensorimotor functions of the GI tract,[3] and the role of probiotics[7,8] and antibiotics[9] in altering the symptoms of IBS provide evidence supporting this issue. Food hygiene, the nature and frequency of GI infections and infestations and the composition of the gut flora areexpected to differ in some Asian countries compared with North America , Europe and Australia/New Zealand . Hence, we sought to review the relationship between gut flora, GI infections and IBS, with particular attention to the Asian published reports.
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The gut contains a vast and complex microbial ecosystem, comprising mainly bacteria, of which most are strict anaerobes; it also includes fungi and viruses.[1,2] The human gastrointestinal (GI) tract contains more than 500 1000 species of bacteria.[3] The bacterial population increases in number and diversity in the more distal parts of the gut; human large intestine contains as many as 10[11 12] organisms per gram of fecal material. [4] Recently, there has been increased interest in the role of qualitative and quantitative changes in gut flora in health and in GI diseases. Irritable bowel syndrome (IBS), a common gastrointestinal disorder of unknown pathogenesis, is one such condition which might be related to changes in the gut flora.
Recent published reports on post -infectious IBS (PI-IBS),[5] small intestinal bacterial overgrowth (SIBO) in IBS, [6] relationships between the gut flora and sensorimotor functions of the GI tract,[3] and the role of probiotics[7,8] and antibiotics[9] in altering the symptoms of IBS provide evidence supporting this issue. Food hygiene, the nature and frequency of GI infections and infestations and the composition of the gut flora areexpected to differ in some Asian countries compared with North America , Europe and Australia/New Zealand . Hence, we sought to review the relationship between gut flora, GI infections and IBS, with particular attention to the Asian published reports.
DOWNLOAD COMPLETE PDF HERE
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