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. 2020 Jan 4;4(1):36-43.
doi: 10.1093/jcag/gwz037. eCollection 2021 Feb.

Clinical Management of the Microbiome in Irritable Bowel Syndrome

Christopher N Andrews  1 , Sacha Sidani  2 , John K Marshall  3
Affiliations

Clinical Management of the Microbiome in Irritable Bowel Syndrome

Christopher N Andrews et al. J Can Assoc Gastroenterol. .

Abstract

Background: A growing body of evidence suggests that dysbiosis contributes to the onset and symptomatology of irritable bowel syndrome (IBS) and other functional bowel disorders. Changes to the gastrointestinal microbiome may contribute to the underlying pathophysiology of IBS.

Methods: The present review summarizes the potential effects of microbiome changes on GI transit, intestinal barrier function, immune dysregulation and inflammation, gut-brain interactions and neuropsychiatric function.

Results: A multimodal approach to IBS management is recommended in accordance with current Canadian guidelines. Pharmacologic treatments are advised to target the presumed underlying pathophysiological mechanism, such as dysregulation of GI transit, peristalsis, intestinal barrier function and pain signalling. The management plan for IBS may also include treatments directed at dysbiosis, including dietary modification and use of probiotics, which may promote the growth of beneficial bacteria, affect intestinal gas production and modulate the immune response; and the administration of periodic short courses of a nonsystemic antibiotic such as rifaximin, which may re-establish microbiota diversity and improve IBS symptoms.

Conclusion: Dysregulated host-microbiome interactions are complex and the use of microbiome-directed therapies will necessarily be empiric in individual patients. A management algorithm comprising microbiome- and nonmicrobiome-directed therapies is proposed.

Keywords: Constipation; Diarrhea; Irritable bowel syndrome; Microbiome; Prebiotics; Probiotics.

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Figures

Figure 1.
Figure 1.
Proposed therapeutic approach to managing the microbiome in IBS. It should be noted that the actual management approach to any given IBS patient will depend on multiple factors; the therapeutic strategies shown should not imply that microbiome-related approaches should be tried before nonmicrobiome related therapies. A multimodal approach comprising dietary/lifestyle, medical, and/or psychological therapies may be required (24).
See this image and copyright information in PMC

References

    1. Gagliardi A, Totino V, Cacciotti F, et al. . Rebuilding the gut microbiota ecosystem. Int J Environ Res Public Health 2018;15(8):E1679. - PMC - PubMed
    1. Giamarellos-Bourboulis E, Tang J, Pyleris E, et al. . Molecular assessment of differences in the duodenal microbiome in subjects with irritable bowel syndrome. Scand J Gastroenterol 2015;50(9):1076–87. - PubMed
    1. Pozuelo M, Panda S, Santiago A, et al. . Reduction of butyrate- and methane-producing microorganisms in patients with irritable bowel syndrome. Sci Rep 2015;5:12693. - PMC - PubMed
    1. Wahlström A, Sayin SI, Marschall HU, et al. . Intestinal crosstalk between bile acids and microbiota and its impact on host metabolism. Cell Metab 2016;24:41–50. - PubMed
    1. Shin JH, Park YH, Sim M, et al. . Serum level of sex steroid hormone is associated with diversity and profiles of human gut microbiome. Res Microbiol 2019;170:192–201. - PubMed

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