The microbiome of patients with irritable bowel syndrome: pathophysiology and applied aspects

Abstract

Irritable bowel syndrome is a clinically and socially significant disease. The pathophysiology, the clinical manifestations of this disease and the prognosis for the patient are closely related to dysbiotic disorders of the intestine. This review summarizes the ideas about changes in the intestinal microbiome in patients with irritable bowel syndrome. The pathogenetically substantiated approaches to the correction of dysbiosis that improving treatment outcomes are also considered. The results of the FLORAVIE clinical trial, which were discussed at the Expert Council “Identification of indications for prescribing probiotics in patients with irritable bowel syndrome” on March 18, 2022, are presented. Members of the Expert Council, Russian and international clinical guidelines emphasize the relevance of targeted probiotics administration. It was noticed that only strain specificity allows predicting a positive clinical response and has a certain evidence base. In this regard, the FLORAVIE study, conducted in real clinical practice in patients with predominantly severe forms of irritable bowel syndrome, is clinically relevant. It has been demonstrated that 30-day administration of the B. longum 35624 probiotic has reduced the severity of irritable bowel syndrome and has improved the quality of life in all subgroups of patients, especially in those with the most severe form of the disease. The data presented indicate that the inclusion of probiotic strains with proven mechanism of action in the complex therapy of irritable bowel syndrome can lead to the transformation of the course of the disease and improve the quality of life of patients. The high level of evidence made it possible to introduce the probiotic strain Bifidobacterium longum 35624 into a number of domestic and foreign guidelines.