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Review
. 2014 Feb;21(1):15-21.
doi: 10.1097/MED.0000000000000032.

Irritable bowel syndrome, inflammatory bowel disease and the microbiome

Giles Major  1 , Robin Spiller
Affiliations
Free PMC article
Review

Irritable bowel syndrome, inflammatory bowel disease and the microbiome

Giles Major et al. Curr Opin Endocrinol Diabetes Obes. 2014 Feb.
Free PMC article

Abstract

Purpose of review: The review aims to update the reader on current developments in our understanding of how the gut microbiota impact on inflammatory bowel disease and the irritable bowel syndrome. It will also consider current efforts to modulate the microbiota for therapeutic effect.

Recent findings: Gene polymorphisms associated with inflammatory bowel disease increasingly suggest that interaction with the microbiota drives pathogenesis. This may be through modulation of the immune response, mucosal permeability or the products of microbial metabolism. Similar findings in irritable bowel syndrome have reinforced the role of gut-specific factors in this 'functional' disorder. Metagenomic analysis has identified alterations in pathways and interactions with the ecosystem of the microbiome that may not be recognized by taxonomic description alone, particularly in carbohydrate metabolism. Treatments targeted at the microbial stimulus with antibiotics, probiotics or prebiotics have all progressed in the past year. Studies on the long-term effects of treatment on the microbiome suggest that dietary intervention may be needed for prolonged efficacy.

Summary: The microbiome represents 'the other genome', and to appreciate its role in health and disease will be as challenging as with our own genome. Intestinal diseases occur at the front line of our interaction with the microbiome and their future treatment will be shaped as we unravel our relationship with it.

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Figures

Box 1
Box 1
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FIGURE 1
FIGURE 1
The overlapping factors that influence IBD, IBS and the microbiome. Schematic representation of the factors that contribute to IBD and IBS. Dashed lines represent pathways requiring further evidence. Barrier function and permeability may be the key to pathogenesis in both disorders and be the critical factor in mucosal interaction with the microbiota. Most relationships with the microbiota will be bidirectional, increasing the complexity of understanding its effects. IBD, inflammatory bowel disease; IBS, irritable bowel syndrome.
See this image and copyright information in PMC

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