Abstract
Irritable bowel syndrome (IBS) is a poorly understood gastrointestinal condition affecting approximately onefifth of the UK population, with a higher prevalence in women and accounting for up to half of referrals to gastroenterology clinics in the UK. It is characterized by abdominal pain, excessive flatus, variable bowel habit and abdominal bloating with no evidence of organic disease. IBS commonly occurs after gastroenteritis or following a course of antibiotics. Suggested aetiologies include motility and psychological disorders and psychophysiological phenomena, although there is also evidence that disruption to the intestinal microbiota can play a role in IBS. Episodes such as hysterectomy, first incidence of bacterial gastroenteritis or a course of antibiotics have been shown to contribute to symptoms compatible with those of IBS. The intestinal microflora in IBS has been shown to differ from that of healthy individuals. Faecal microfloras of IBS patients har bour higher numbers of facultative organisms, such as Klebsiella spp. and enterococci, and low numbers of lactobacilli and bifidobacteria. The role of probiotics in IBS has not been clearly defined. Some studies have shown improvements in pain and flatulence in response to probiotic supplementation, while others have shown no symptomatic or objective improvements. Administration of probiotics reduced caecal and faecal yeast proliferation in IBS patients treated with antibiotics, suggesting that they prevent the disruption of the intestinal microbiota known to be associated with IBS. It is possible that the role of probiotics in the management of IBS will lie in prevention, rather than cure. Keywords: IBS; microflora; probiotics
Highlights
Irritable bowel syndrome (IBS) is a frequent and often debilitating bowel disorder in which patients commonly present with bloating and abdominal pain
The microbiota of IBS patients had significantly lower numbers of Enterobacteriaceae, lactobacilli and bifidobacteria compared with controls
IBS patients are not a homogeneous group to study and, as such, few studies have been undertaken to investigate the role of probiotics in this
Summary
Irritable bowel syndrome (IBS) is a frequent and often debilitating bowel disorder in which patients commonly present with bloating and abdominal pain. It is thought that IBS affects in the region of onefifth of the UK population at some stage in their lives, 60Á75% symptomatic people do not visit their general practitioner [4] This may well be related to the severity of their symptoms, since IBS can be a chronic condition in which symptom-free periods and relapses occur [5]. Stability of the microbiota is established by several mechanisms including gastric acidity, gut mobility, bile, products of immune cells in the gut epithelium, competition between microorganisms for nutrients and availability of intestinal binding sites [7]. In certain circumstances, this equilibrium can become unbalanced through diet, geographical location, pathological conditions, surgery to the gastrointestinal tract and, most signifi-.
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