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Altered gastrointestinal microbiota in irritable bowel syndrome and its modification by diet: probiotics, prebiotics and the low FODMAP diet.
Proc Nutr Soc. 2016 08; 75(3):306-18.PN

Abstract

Irritable bowel syndrome (IBS) is a functional bowel disorder characterised by abdominal pain or discomfort with disordered defecation. This review describes the role of the gastrointestinal (GI) microbiota in the pathogenesis of IBS and how dietary strategies to manage symptoms impact on the microbial community. Evidence suggests a dysbiosis of the luminal and mucosal colonic microbiota in IBS, frequently characterised by a reduction in species of Bifidobacteria which has been associated with worse symptom profile. Probiotic supplementation trials suggest intentional modulation of the GI microbiota may be effective in treating IBS. A smaller number of prebiotic supplementation studies have also demonstrated effectiveness in IBS whilst increasing Bifidobacteria. In contrast, a novel method of managing IBS symptoms is the restriction of short-chain fermentable carbohydrates (low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet). Studies consistently demonstrate clinical effectiveness of the low FODMAP diet in patients with IBS. However, one unintentional consequence of this dietary intervention is its impact on the microbiota. This leads to an interesting paradox; namely, increasing luminal Bifidobacteria through probiotic supplementation is associated with a reduction in IBS symptoms while in direct conflict to this, the low FODMAP diet has clinical efficacy but markedly reduces luminal Bifidobacteria concentration. Given the multifactorial aetiology of IBS, the heterogeneity of symptoms and the complex and diverse nature of the microbiome, it is probable that both interventions are effective in patient subgroups. However combination treatment has never been explored and as such, presents an exciting opportunity for optimising clinical management, whilst preventing potentially deleterious effects on the GI microbiota.

Authors+Show Affiliations

King's College London,Diabetes and Nutritional Sciences Division,London SE1 9NH,UK.King's College London,Diabetes and Nutritional Sciences Division,London SE1 9NH,UK.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

26908093

Citation

Staudacher, Heidi M., and Kevin Whelan. "Altered Gastrointestinal Microbiota in Irritable Bowel Syndrome and Its Modification By Diet: Probiotics, Prebiotics and the Low FODMAP Diet." The Proceedings of the Nutrition Society, vol. 75, no. 3, 2016, pp. 306-18.
Staudacher HM, Whelan K. Altered gastrointestinal microbiota in irritable bowel syndrome and its modification by diet: probiotics, prebiotics and the low FODMAP diet. Proc Nutr Soc. 2016;75(3):306-18.
Staudacher, H. M., & Whelan, K. (2016). Altered gastrointestinal microbiota in irritable bowel syndrome and its modification by diet: probiotics, prebiotics and the low FODMAP diet. The Proceedings of the Nutrition Society, 75(3), 306-18. https://doi.org/10.1017/S0029665116000021
Staudacher HM, Whelan K. Altered Gastrointestinal Microbiota in Irritable Bowel Syndrome and Its Modification By Diet: Probiotics, Prebiotics and the Low FODMAP Diet. Proc Nutr Soc. 2016;75(3):306-18. PubMed PMID: 26908093.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Altered gastrointestinal microbiota in irritable bowel syndrome and its modification by diet: probiotics, prebiotics and the low FODMAP diet. AU - Staudacher,Heidi M, AU - Whelan,Kevin, Y1 - 2016/02/24/ PY - 2016/2/25/entrez PY - 2016/2/26/pubmed PY - 2017/9/29/medline KW - FODMAP KW - FODMAP fermentable oligosaccharides KW - GI gastrointestinal KW - GOS galacto-oligosaccharides KW - IBS irritable bowel syndrome KW - IBS-D diarrhoea-predominant IBS KW - Irritable bowel syndrome KW - Prebiotic KW - Probiotic KW - RCT randomised control trial KW - disaccharides KW - monosaccharides and polyols SP - 306 EP - 18 JF - The Proceedings of the Nutrition Society JO - Proc Nutr Soc VL - 75 IS - 3 N2 - Irritable bowel syndrome (IBS) is a functional bowel disorder characterised by abdominal pain or discomfort with disordered defecation. This review describes the role of the gastrointestinal (GI) microbiota in the pathogenesis of IBS and how dietary strategies to manage symptoms impact on the microbial community. Evidence suggests a dysbiosis of the luminal and mucosal colonic microbiota in IBS, frequently characterised by a reduction in species of Bifidobacteria which has been associated with worse symptom profile. Probiotic supplementation trials suggest intentional modulation of the GI microbiota may be effective in treating IBS. A smaller number of prebiotic supplementation studies have also demonstrated effectiveness in IBS whilst increasing Bifidobacteria. In contrast, a novel method of managing IBS symptoms is the restriction of short-chain fermentable carbohydrates (low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet). Studies consistently demonstrate clinical effectiveness of the low FODMAP diet in patients with IBS. However, one unintentional consequence of this dietary intervention is its impact on the microbiota. This leads to an interesting paradox; namely, increasing luminal Bifidobacteria through probiotic supplementation is associated with a reduction in IBS symptoms while in direct conflict to this, the low FODMAP diet has clinical efficacy but markedly reduces luminal Bifidobacteria concentration. Given the multifactorial aetiology of IBS, the heterogeneity of symptoms and the complex and diverse nature of the microbiome, it is probable that both interventions are effective in patient subgroups. However combination treatment has never been explored and as such, presents an exciting opportunity for optimising clinical management, whilst preventing potentially deleterious effects on the GI microbiota. SN - 1475-2719 UR - https://www.unboundmedicine.com/medline/citation/26908093/Altered_gastrointestinal_microbiota_in_irritable_bowel_syndrome_and_its_modification_by_diet:_probiotics_prebiotics_and_the_low_FODMAP_diet_ L2 - https://www.cambridge.org/core/product/identifier/S0029665116000021/type/journal_article DB - PRIME DP - Unbound Medicine ER -