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Modulation of the gut microbiota: a focus on treatments for irritable bowel syndrome.
Postgrad Med 2017; 129(8):872-888PM

Abstract

Irritable bowel syndrome (IBS), which is characterized by recurrent abdominal pain and disordered bowel habits, is one of the most common functional bowel disorders. IBS is a substantial burden on both patient health-related quality of life and healthcare costs. Several pathophysiologic mechanisms have been postulated for the occurrence of IBS, including altered gastrointestinal motility, visceral hypersensitivity, changes in gut permeability, immune activation, gut-brain dysregulation, central nervous system dysfunction, and changes in the gut microbiota. Of note, both qualitative and quantitative differences have been observed in the gut microbiota of a population with IBS versus a healthy population. Because of the substantial interest in the gut microbiota and its role as a therapeutic target in IBS, this article provides an overview of specific interventions with the potential to modulate the gut microbiota in IBS, including elimination diets, prebiotics, probiotics, synbiotics, and nonsystemic antibiotics. Although probiotics and synbiotics are generally well tolerated, differences in the composition and concentration of different bacterial species and inclusion or exclusion of prebiotic components varies widely across studies and has prevented strong recommendations on their use in IBS. For nonsystemic antibiotics, rifaximin is indicated in the United States for the treatment of IBS with diarrhea in adults and has been shown to be efficacious and well tolerated in well-designed clinical trials. Overall, more consistent evidence is needed regarding the efficacy and safety of elimination diets, prebiotics, probiotics, and synbiotics for the treatment of patients with IBS. Furthermore, additional well-designed studies are needed that examine alterations in the gut microbiota that occur with these interventions and their potential associations with clinical symptoms of IBS.

Authors+Show Affiliations

a Division of Gastroenterology & Hepatology , Mayo Clinic , Scottsdale , AZ , USA.a Division of Gastroenterology & Hepatology , Mayo Clinic , Scottsdale , AZ , USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

28936910

Citation

Harris, Lucinda A., and Noemi Baffy. "Modulation of the Gut Microbiota: a Focus On Treatments for Irritable Bowel Syndrome." Postgraduate Medicine, vol. 129, no. 8, 2017, pp. 872-888.
Harris LA, Baffy N. Modulation of the gut microbiota: a focus on treatments for irritable bowel syndrome. Postgrad Med. 2017;129(8):872-888.
Harris, L. A., & Baffy, N. (2017). Modulation of the gut microbiota: a focus on treatments for irritable bowel syndrome. Postgraduate Medicine, 129(8), pp. 872-888. doi:10.1080/00325481.2017.1383819.
Harris LA, Baffy N. Modulation of the Gut Microbiota: a Focus On Treatments for Irritable Bowel Syndrome. Postgrad Med. 2017;129(8):872-888. PubMed PMID: 28936910.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Modulation of the gut microbiota: a focus on treatments for irritable bowel syndrome. AU - Harris,Lucinda A, AU - Baffy,Noemi, Y1 - 2017/10/13/ PY - 2017/9/25/pubmed PY - 2017/11/29/medline PY - 2017/9/23/entrez KW - Antibiotic KW - constipation KW - diarrhea KW - diet KW - irritable bowel syndrome KW - microbiota KW - prebiotic KW - probiotic KW - rifaximin SP - 872 EP - 888 JF - Postgraduate medicine JO - Postgrad Med VL - 129 IS - 8 N2 - Irritable bowel syndrome (IBS), which is characterized by recurrent abdominal pain and disordered bowel habits, is one of the most common functional bowel disorders. IBS is a substantial burden on both patient health-related quality of life and healthcare costs. Several pathophysiologic mechanisms have been postulated for the occurrence of IBS, including altered gastrointestinal motility, visceral hypersensitivity, changes in gut permeability, immune activation, gut-brain dysregulation, central nervous system dysfunction, and changes in the gut microbiota. Of note, both qualitative and quantitative differences have been observed in the gut microbiota of a population with IBS versus a healthy population. Because of the substantial interest in the gut microbiota and its role as a therapeutic target in IBS, this article provides an overview of specific interventions with the potential to modulate the gut microbiota in IBS, including elimination diets, prebiotics, probiotics, synbiotics, and nonsystemic antibiotics. Although probiotics and synbiotics are generally well tolerated, differences in the composition and concentration of different bacterial species and inclusion or exclusion of prebiotic components varies widely across studies and has prevented strong recommendations on their use in IBS. For nonsystemic antibiotics, rifaximin is indicated in the United States for the treatment of IBS with diarrhea in adults and has been shown to be efficacious and well tolerated in well-designed clinical trials. Overall, more consistent evidence is needed regarding the efficacy and safety of elimination diets, prebiotics, probiotics, and synbiotics for the treatment of patients with IBS. Furthermore, additional well-designed studies are needed that examine alterations in the gut microbiota that occur with these interventions and their potential associations with clinical symptoms of IBS. SN - 1941-9260 UR - https://www.unboundmedicine.com/medline/citation/28936910/Modulation_of_the_gut_microbiota:_a_focus_on_treatments_for_irritable_bowel_syndrome_ L2 - http://www.tandfonline.com/doi/full/10.1080/00325481.2017.1383819 DB - PRIME DP - Unbound Medicine ER -