Abstract
Diet plays an important role not only in the pathophysiology of irritable bowel syndrome (IBS), but also as a tool that improves symptoms and quality of life. The effects of diet seem to be a result of an interaction with the gut bacteria and the gut endocrine cells. The density of gut endocrine cells is low in IBS patients, and it is believed that this abnormality is the direct cause of the symptoms seen in IBS patients. The low density of gut endocrine cells is probably caused by a low number of stem cells and low differentiation progeny toward endocrine cells. A low fermentable oligo-, di-, monosaccharide, and polyol (FODMAP) diet and fecal microbiota transplantation (FMT) restore the gut endocrine cells to the level of healthy subjects. It has been suggested that our diet acts as a prebiotic that favors the growth of a certain types of bacteria. Diet also acts as a substrate for gut bacteria fermentation, which results in several by-products. These by-products might act on the stem cells in such a way that the gut stem cells decrease, and consequently, endocrine cell numbers decrease. Changing to a low-FODMAP diet or changing the gut bacteria through FMT improves IBS symptoms and restores the density of endocrine cells.
Highlights
It has been estimated that 12.1% of the world’s population suffers from irritable bowel syndrome (IBS) [1,2]
IBS patients are divided into four subtypes: diarrhea-predominant (IBS-D), constipation-predominant (IBS-C), mixed diarrhea and constipation (IBS-M), and patients who meet the diagnostic criteria for IBS, but whose bowel habits cannot be accurately categorized (IBS-U) [5,6]
IBS patients have a lower diversity of gut bacteria than healthy subjects [86,88,89,90,91,92,93]
Summary
It has been estimated that 12.1% of the world’s population suffers from irritable bowel syndrome (IBS) [1,2]. The main symptom of IBS is recurrent abdominal pain associated with a change in the bowel habits according to Rome IV criteria [3]. The diagnosis of IBS is based mainly on an assessment of the symptoms as described by Rome criteria [4]. Sporadic IBS includes patients who have had symptoms for a long time without any associated events. The etiology of IBS is not completely understood, but several factors are believed to play a pivotal role in the pathophysiology of IBS These factors are genetics, diet, gut microbiota, gut endocrine cells, and low-grade inflammation [1]. Low-grade inflammation occurs in some IBS patients, but far from all [1]. Gut microbiota, and gut endocrine cells interact with each other in a way that affect IBS symptoms. The present review is an attempt to clarify this interaction and the possible implications for everyday clinical work
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