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A review of the role of the gut microflora in irritable bowel syndrome and the effects of probiotics

Published online by Cambridge University Press:  09 March 2007

J. A. J. Madden
Affiliation:
Gastroenterology Research Unit, Unit E7, Box 201 A, Addenbrookes NHS Trust, Hillņs Road, Cambridge CB2 2QQ, UK
J. O. Hunter*
Affiliation:
Gastroenterology Research Unit, Unit E7, Box 201 A, Addenbrookes NHS Trust, Hillņs Road, Cambridge CB2 2QQ, UK
*
*Corresponding author: Dr J. O. Hunter, fax +44 1223 211443, email john.hunter@addenbrookes.nhs.uk
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Abstract

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Irritable bowel syndrome (IBS) is a multi-factorial gastrointestinal condition affecting 8–22 % of the population with a higher prevalence in women and accounting for 20–50 % of referrals to gastroenterology clinics. It is characterised by abdominal pain, excessive flatus, variable bowel habit and abdominal bloating for which there is no evidence of detectable organic disease. Suggested aetiologies include gut motility and psychological disorders, psychophysiological phenomena and colonic malfermentation. The faecal microflora in IBS has been shown to be abnormal with higher numbers of facultative organisms and low numbers of lactobacilli and bifidobacteria. Although there is no evidence of food allergy in IBS, food intolerance has been identified and exclusion diets are beneficial to many IBS patients. Food intolerance may be due to abnormal fermentation of food residues in the colon, as a result of disruption of the normal flora. The role of probiotics in IBS has not been clearly defined. Some studies have shown improvements in pain and flatulence in response to probiotic administration, whilst others have shown no symptomatic improvement. It is possible that the future role of probiotics in IBS will lie in prevention, rather than cure.

Type
Research Article
Copyright
Copyright © The Nutrition Society 2002

References

Alun Jones, V, McLaughlin, P, Shorthouse, M, Workman, E & Hunter, JO (1982) Food intolerance: a major factor in the pathogenesis of irritable bowel syndrome. Lancet 2, 11151117.CrossRefGoogle Scholar
Alun Jones, V, Wilson, AJ, Hunter, JO & Robinson, RE (1984) The aetiological role of antibiotic prophylaxis with hysterectomy in irritable bowel syndrome. Journal of Obstetrics and Gynaecology 5, Suppl. 1, S22S23.CrossRefGoogle Scholar
Balsari, A, Ceccarelli, A, Dubini, F, Fesce, E & Poli, G (1982) The fecal microbial population in the irritable bowel syndrome. Microbiologica 5, 185194.Google ScholarPubMed
Bradley, HK, Wyatt, GM, Bayliss, CE & Hunter, JO (1987) Instability in the faecal flora of a patient suffering from food-related irritable bowel syndrome. Journal of Medical Microbiology 23, 2932.CrossRefGoogle ScholarPubMed
Camilleri, M (2001) Management of the irritable bowel syndrome. Gastroenterology 120, 652668.CrossRefGoogle ScholarPubMed
Cummings, JH & Macfarlane, GT (1991) The control and consequences of bacterial fermentation in the colon. Journal of Applied Bacteriology 70, 443459.CrossRefGoogle Scholar
Farthing, MJG (1995) Irritable bowel, irritable body, or irritable brain? British Medical Journal 310, 171175.CrossRefGoogle ScholarPubMed
Finegold, SM, Atterbury, HR & Sutter, SL (1983) Normal indigenous intestinal flora. In Human Intestinal Microflora in Health and Disease, pp. 331 [Hentges, D, editor]. London: Academic Press.CrossRefGoogle Scholar
Guarner, F & Schaafsma, GJ (1998) Probiotics. International Journal of Food Microbiology 39, 237238.CrossRefGoogle ScholarPubMed
Gwee, KA (2001) Postinfectious irritable bowel syndrome. Current Treatment Options in Gastroenterology 4, 287291.CrossRefGoogle ScholarPubMed
Gwee, KA, Graham, JC, McKendrick, MW, Collins, SM, Marshall, JS, Walters, SJ & Read, NW (1996) Psychometric scores and persistence of irritable bowel after infectious diarrhoea. Lancet 347, 617618.CrossRefGoogle ScholarPubMed
Haderstorfer, B, Psycholgin, D, Whitehead, WE & Schuster, MM (1989) Intestinal gas production from bacterial fermentation of undigested carbohydrate in irritable bowel syndrome. American Journal of Gastroenterology 84, 375378.Google ScholarPubMed
Halpern, GM, Prindiville, T, Blankenburg, M, Hsia, T & Gershwin, ME (1996) Treatment of irritable bowel syndrome with Lacteol Fort: a randomized, double-blind, cross-over trial. American Journal of Gastroenterology 91, 15791585.Google Scholar
Hill, MJ (1995) The normal gut bacterial flora. In Role of Gut Bacteria in Human Toxicology and Pharmacology, pp. 319 [Hill, MJ, editor]. London: Taylor & Francis.Google Scholar
Hooker, KD & dePiro, JT (1988) Effect of antimicrobial therapy on bowel flora. Clinical Pharmacology 7, 878888.Google Scholar
Hunter, JO (1991) Food allergy – or enterometabolic disorder? Lancet 338, 495496.CrossRefGoogle ScholarPubMed
Hunter, JO & Alun Jones, V (1985) Studies on the pathogenesis of irritable bowel syndrome produced by food intolerance. In Irritable Bowel Syndrome, pp. 185190 [Read, NW, editor]. London: Grune & Stratton Ltd.Google ScholarPubMed
Hunter, JO, Lee, AJ, King, TS, Barratt, MEJ, Linggood, MA & Blades, JA (1996) Enterococcus faecium strain PR88 – an effective probiotic. Gut 38, Suppl. 1, A62.Google Scholar
Jacobsen, MB, Aukrust, P, Kittang, E, Müller, F, Ueland, T, Bratlie, J, Bjerkeli, V & Vatn, MH (2000) Relation between food provocation and systemic immune activation in patients with food intolerance. Lancet 356, 400401.CrossRefGoogle ScholarPubMed
King, TS, Elia, M & Hunter, JO (1998) Abnormal colonic fermentation in irritable bowel syndrome. Lancet 352, 11871189.CrossRefGoogle ScholarPubMed
Koide, A, Yamaguchi, T, Odaka, T, Koyama, H, Tsuyuguchi, T, Kitahara, H, Ohto, M & Saisho, H (2000) Quantitative analysis of bowel gas using plain abdominal radiograph in patients with irritable bowel syndrome. American Journal of Gastroenterology 95, 17351741.CrossRefGoogle ScholarPubMed
Lidbeck, A & Nord, CE (1993) Lactobacilli and the normal human anaerobic microflora. Clinical Infectious Diseases 16, S181S187.CrossRefGoogle ScholarPubMed
Lidbeck, A & Nord, CE (1994) Lactobacilli, normal human microflora and antimicrobial treatment. In Human Health: The Contribution of Microorganisms, pp. 95110 [Gibson, SAW, editor]. London: Springer-Verlag Limited.CrossRefGoogle Scholar
Locke, GR, Zinsmeister, AR, Talley, NT, Fett, SL & Melton, J (2000) Risk factors for irritable bowel syndrome: role of analgesics and food sensitivities. American Journal of Gastroenterology 95, 157165.CrossRefGoogle ScholarPubMed
Macfarlane, GT & Gibson, GR (1995) Microbiological aspects of short chain fatty acid production in the large bowel. In Physiological and Clinical Aspects of Short Chain Fatty Acid Metabolism, pp. 87105 [Cummings, JH, Rombeau, JL and Sakata, T, editors]. Cambridge: Cambridge University Press.Google Scholar
Madden, JAJ, Plummer, S, Sen, S, Dear, K, Tarry, S & Hunter, JO (2001) Comparison of the caecal and faecal microflora of healthy subjects and patients with irritable bowel syndrome (IBS). Gut 48, Suppl. 1, A58.Google Scholar
Marshall, JC (1999) Gastrointestinal flora and its alterations in critical illness. Current Opinions in Nutrition and Metabolic Care 2, 405411.CrossRefGoogle ScholarPubMed
Maxwell, PR, Mendall, MA & Kumar, D (1997) Irritable bowel syndrome. Lancet 350, 16911695.CrossRefGoogle ScholarPubMed
Mendall, MA & Kumar, D (1998) Antibiotic use, childhood affluence and irritable bowel syndrome. European Journal of Gastroenterology and Hepatology 10, 5962.CrossRefGoogle ScholarPubMed
Nanda, R, James, R, Smith, H, Dudley, CR & Jewell, DP (1989) Food intolerance and the irritable bowel syndrome. Gut 30, 10991104.CrossRefGoogle ScholarPubMed
Neal, KR, Hebden, J & Spiller, R (1997) Prevalence of gastrointestinal symptoms six months after bacterial gastroenteritis and risk factors for the development of the irritable bowel syndrome: postal survey of patients. British Medical Journal 314, 779782.CrossRefGoogle ScholarPubMed
Neilson, OH, Jorgenson, S, Pederson, K & Justensen, T (1994) Microbiological evaluation of jejunal aspirates and faecal samples after oral administration of bifidobacteria and lactic acid bacteria. Journal of Applied Bacteriology 76, 469474.Google Scholar
Niedzielin, K, Kordecki, H & Kosik, R (1998) New possibility in the treatment of irritable bowel syndrome: probiotics as a modification of the microflora of the colon. Gastroenterology 114, A402.CrossRefGoogle Scholar
Nobaek, S, Johansson, ML, Molin, G, Ahrne, S & Jeppsson, B (2000) Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome. American Journal of Gastroenterology 95, 12311238.CrossRefGoogle ScholarPubMed
O'Sullivan, MA & O'Morain, CA (2000) Bacterial supplementation in the irritable bowel syndrome. A randomised double-blind placebo-controlled crossover study. Digestive Diseases and Science 32, 302304.Google ScholarPubMed
Parker, TJ, Naylor, SJ, Riordan, AM & Hunter, JO (1995) Management of patients with food intolerance in irritable bowel syndrome: the development and use of an exclusion diet. Journal of Nutrition and Dietetics 8, 159166.CrossRefGoogle Scholar
Pimental, M, Chow, EJ & Lin, HC (2000) Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. American Journal of Gastroenterology 95, 35033506.CrossRefGoogle Scholar
Rodríguez, LAG & Ruigómez, A (1999) Increased risk of irritable bowel syndrome after bacterial gastroenteritis: cohort study. British Medical Journal 318, 565566.CrossRefGoogle ScholarPubMed
Savage, DC (1977) Microbial ecology of the gastrointestinal tract. Annual Reviews in Microbiology 31, 107133.CrossRefGoogle ScholarPubMed
Sen, S, Mullan, M, Parker, TJ, Woolner, J, Tarry, SA & Hunter, JO (2001) Effects of Lactobacillus plantarum 299v on symptoms and colonic fermentation in irritable bowel syndrome (IBS). Gut 48, Suppl. 1, A57.Google Scholar
Serra, J, Azpiroz, F & Malagelada, J-R (2001) Impaired transit and tolerance of intestinal gas in the irritable bowel syndrome. Gut 48, 1419.CrossRefGoogle ScholarPubMed
Stephen, AM & Cummings, JH (1980) Mechanism of action of dietary fibre in the human colon. Nature 284, 5753, 283284.CrossRefGoogle ScholarPubMed
Thompson, WG, Longstreth, GF, Drossman, DA, Heaton, KW, Irvine, EJ & Muller-Lissner, SA (1999) Functional bowel disorders and functional gastrointestinal disorders. Gut 45, 11431147.CrossRefGoogle Scholar
Van der Waiij, D (1983) Antibiotic Choice: The Importance of Colonisation Resistance. Chichester: Research Studies Press.Google Scholar
Witsell, DL, Garrett, CG, Yarbrough, WG, Dorrestein, SP, Drake, AF & Weissler, MC (1995) Effect of Lactobacillus acidophilus on antibiotic-associated gastrointestinal morbidity: a prospective randomized trial. Journal of Otolaryngology 24, 230233.Google ScholarPubMed
Wyatt, GM, Bayliss, CE, Lakey, AF, Bradley, HK, Hunter, JO & Alun Jones, V (1988) The faecal flora of two patients with food-related irritable bowel syndrome during challenge with symptom-provoking foods. Journal of Medical Microbiology 26, 295299.CrossRefGoogle ScholarPubMed
Zar, S, Kumar, D & Benson, MJ (2001) Food hypersensitivity and irritable bowel syndrome. Alimentary Pharmacology and Therapeutics 15, 439449.CrossRefGoogle ScholarPubMed