Irritable Bowel Syndrome Symptoms Research Articles

The Role and the Regulation of NLRP3 Inflammasome in Irritable Bowel Syndrome: A Narrative Review

Irritable bowel syndrome (IBS) is a chronic disorder of the gastrointestinal tract. Its pathogenesis involves multiple factors, including visceral hypersensitivity and immune activation. NLRP3 inflammasome is part of the nucleotide-binding oligomerization domain-like receptor (NLR) family, a crucial component of the innate immune system. Preclinical studies have demonstrated that inhibiting NLRP3 reduces visceral sensitivity and IBS symptoms, like abdominal pain, and diarrhea, suggesting that targeting the NLRP3 might represent a novel therapeutic approach for IBS. This review aims to assess the NLRP3 inhibitors (tranilast, β-hydroxybutyrate, Chang-Kang-fang, paeoniflorin, coptisine, BAY 11-7082, and Bifidobacterium longum), highlighting the signaling pathways, and their potential role in IBS symptoms management was assessed. Although premature, knowledge of the action of synthetic small molecules, phytochemicals, organic compounds, and probiotics might make NLRP3 a new therapeutic target in the quiver of physicians’ therapeutic choices for IBS symptoms management.

Clinical Trial: Study to Investigate the Efficacy and Safety of the Alpha-2-Delta Ligand PD-217,014 in Patients With Irritable Bowel Syndrome.

Despite the emergence of drugs to treat irritable bowel syndrome (IBS), improving abdominal pain can still be challenging. α2δ ligands, such as gabapentin and pregabalin, are sometimes used off-label to tackle this problem. However, evidence for efficacy is limited, and no large-scale studies have been published. To study the efficacy of the α2δ ligand PD-217,014 in IBS. This multi-centre, double-blind, randomised, placebo-controlled, parallel group study randomised participants with Rome II-defined IBS to 150 or 300 mg b.d. of PD-217,014 or placebo b.d. for 4 weeks. The primary efficacy endpoint was responder, defined as having adequate relief of abdominal pain/discomfort for ≥ 50% of the active treatment period. Key secondary endpoints were change from baseline in abdominal pain, bloating, stool frequency/consistency, and global assessment of IBS symptoms. We randomised 330 participants [aged 19-73 years; 209 (65%) female] satisfying Rome II criteria, 322 (98%) were treated, and of whom 271 (84%) completed the study. In this study, 321 satisfied Rome IV criteria. Neither dose of PD-217,014 improved the percentage of participants reporting adequate relief of abdominal pain/discomfort compared with placebo, either using the Rome II-defined total cohort or Rome II and IV IBS bowel habit sub-types. There were similar observations for secondary endpoints, and no association between abdominal pain or anxiety levels at baseline with participant improvement. PD-217,014 was generally well tolerated. This first large, dose-ranging trial examining the efficacy of PD-217,014 showed no significant efficacy in participants with IBS or bowel habit sub-types, irrespective of their pain and anxiety levels.

Impact of Microbiota on Irritable Bowel Syndrome Pathogenesis and Management: A Narrative Review

Irritable bowel syndrome (IBS) is a prevalent gastrointestinal disorder, affecting 3–5% of the global population and significantly impacting patients’ quality of life and healthcare resources. Alongside physical symptoms such as abdominal pain and altered bowel habits, many individuals experience psychological comorbidities, including anxiety and depression. Recent research has highlighted the critical role of the gut microbiota in IBS, with dysbiosis, characterized by an imbalance in microbial diversity, frequently observed in patients. The gut–brain axis, a bidirectional communication network between the gut and central nervous system, plays a central role in the development of IBS symptoms. Although interventions such as probiotics, prebiotics, synbiotics, and fecal microbiota transplantation (FMT) have demonstrated potential in modulating the gut microbiota and alleviating symptoms, their efficacy remains an area of ongoing investigation. This review examines the interactions between the gut microbiota, immune system, and brain, emphasizing the need for personalized therapeutic strategies. Future research should aim to identify reliable microbiota-based biomarkers for IBS and refine microbiome-targeted therapies to enhance patient outcomes.

Magnitude of depression and anxiety in patients with irritable bowel syndrome: A comparative cross-sectional study.

Objective: To find out the magnitude of depression and anxiety in patients with irritable bowel syndrome (IBS) presenting at a tertiary care Gastroenterology clinic of Karachi, Pakistan. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital & Medical College, Karachi, Pakistan. Period: February 2022 to July 2022. Methods: Patients of both genders, aged 18 – 50 years and newly diagnosed IBS patients (as per ROME-IV criteria) were assessed. Patient’s attendants, hospital staff, and students without any symptoms of IBS were taken as healthy controls. Non-probability, consecutive sampling technique was adopted. Depression and anxiety were determined using hospital anxiety and depression scale (HADS). The collected data was entered and analyzed using IBM-SPSS Statistics, version 26.0. Chi-square test was applied to compare data taking p<0.05 as significant. Results: This study was conducted on 110 IBS and 110 healthy controls. The mean age of the IBS group was 32.81± 1.12 years while that of the healthy group was 37.60 ± 1.08 years. There were 47 (42.7%) males and 63 (57.3%) females in IBS group while 72 (65.5%) males and 38 (34.5%) females in healthy groups. The prevalence of anxiety was 52.7% and that of depression was 49% according to HAD Scale in IBS group (p<0.001). Conclusion: A strong association of IBS with anxiety and depression was noted, highlighting the necessity of screening for these disorders in gastrointestinal clinics.

Effect of Pilates Exercises on Symptoms of Irritable Bowel Syndrome in Women: A Randomized Controlled Trial

Objective: Treatment of irritable bowel syndrome (IBS) is challenging, calling for therapeutic strategies other than pharmacologicaltreatment. This study aimed to investigate the effects of Pilates exercises on IBS symptoms and severity, frequency of complete spontaneous bowel movements, fatigue, anxiety, depression, and body weight in women with IBS.Methods: Sixty women aged 20–45 with IBS were randomized into two groups: a study group (n = 30) receiving an 8-week Pilates program (2 sessions/week) plus dietary advice and a control group (n = 30) receiving dietary advice only. Inclusion criteria included moderate-to-severe IBS diagnosed via Rome IV criteria. The outcome measures were the IBS severity scoring system (IBS-SSS), the frequency of complete spontaneous bowel movements, the modified fatigue impact scale (MFIS), hospital anxiety and depression (HADS) scale, and body weight (BW).Results: The study group showed more significant improvements than the control group in total IBS-SSS score (Cohen d = 0.73, p <0.001), frequency of complete spontaneous bowel movements (Cohen d = 0.50, p <0.001), total MFIS score (Cohen d = 0.74, p < 0.001), anxiety (Cohen d = 0.56, p < 0.001), and depression (Cohen d= 0.64, p <0.001). The study group also showed a significant reduction in body weight compared to baseline (p < 0.05). The control group showed significant improvements in all outcomes, except body weight, compared to baseline (p < 0.05).Conclusion: Adding Pilates to dietary advice significantly enhances IBS outcomes, bowel movement frequency, fatigue, anxiety, and depression compared to dietary advice alone. However, dietary advice alone also yielded notable benefits.

Exploring Gut Microbiota Imbalance in Irritable Bowel Syndrome: Potential Therapeutic Effects of Probiotics and Their Metabolites.

Irritable bowel syndrome is a common functional gastrointestinal disorder characterized by recurrent abdominal discomfort, bloating, cramping, flatulence, and changes in bowel movements. The pathophysiology of IBS involves a complex interaction between motor, sensory, microbiological, immunological, and psychological factors. Diversity, stability, and metabolic activity of the gut microbiota are frequently altered in IBS, thus leading to a situation of gut dysbiosis. Therefore, the use of probiotics and probiotic-derived metabolites may be helpful in balancing the gut microbiota and alleviating irritable bowel syndrome symptoms. This review aimed to report and consolidate recent progress in understanding the role of gut dysbiosis in the pathophysiology of IBS, as well as the current studies that have focused on the use of probiotics and their metabolites, providing a foundation for their potential beneficial effects as a complementary and alternative therapeutic strategy for this condition due to the current absence of effective and safe treatments.

Efficacy and Safety of a Mixture of Microencapsulated Sodium Butyrate, Probiotics, and Short Chain Fructooligosaccharides in Patients with Irritable Bowel Syndrome—A Randomized, Double-Blind, Placebo-Controlled Study

Objective: Biotics are increasingly being used in the treatment of irritable bowel syndrome (IBS). This study aimed to assess the efficacy and safety of a mixture of microencapsulated sodium butyrate, probiotics (Lactocaseibacillus rhamnosus DSM 26357, Lactobacillus acidophilus DSM 32418, Bifidobacterium longum DSM 32946, Bifidobacterium bifidum DSM 32403, and Bifidobacterium lactis DSM 32269), and short-chain fructooligosaccharides (scFOSs) in IBS patients. Methods: This was a randomized, double-blind, placebo-controlled trial involving 120 adult participants with IBS. The primary outcome of the 12-week intervention was the improvement in IBS symptoms and quality of life (QOL), assessed with the use of IBS-Adequate Relief (IBS-AR), IBS-Global Improvement Scale (IBS-GIS), IBS-Symptom Severity Score (IBS-SSS), and IBS-QOL. Secondary outcomes were the number and type of stools (assessed via the Bristol Stool Form scale), patient-recorded symptoms, anthropometric parameters, and levels of selected inflammatory cytokines. Results: As early as at 4 weeks, there was a higher percentage of patients in the biotic group reporting adequate relief of symptoms (based on IBS-AR) than in the placebo group (64.7% vs. 42.0%, respectively, p = 0.023). At 12 weeks, fewer patients in the biotic group reported a ‘worsening of symptoms’ (based on IBS-GIS) than in the placebo group (5.9% vs. 16.0% respectively, p = 0.015). There were no significant differences between groups in IBS-QOL or IBS-SSS or any of the secondary outcome measures except the patient-recorded ‘urgency to defecate’ (p = 0.015) at week 12, which was significantly lower in the biotic group. The intervention was safe and well tolerated. Conclusions: A biotic mixture consisting of microencapsulated butyrate, probiotics, and small amounts of scFOSs is safe and effective in improving gastrointestinal symptoms in patients with IBS.

The Role of Gut Microbiome in Irritable Bowel Syndrome: Implications for Clinical Therapeutics.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder (FGID) characterized by chronic or recurrent gastrointestinal symptoms without organic changes, and it is also a common disorder of gut-brain interaction (DGBIs).. The symptoms of IBS not only affect the quality of life for individual patients but also place a significant burden on global healthcare systems. The lack of established and universally applicable biomarkers for IBS, along with the substantial variability in symptoms and progression, presents challenges in developing effective clinical treatments. In recent years, preclinical and clinical studies have linked the pathogenesis of IBS to alterations in the composition and function of the intestinal microbiota. Within the complex microbial community of the gut, intricate metabolic and spatial interactions occur among its members and between microbes and their hosts. Amid the multifaceted pathophysiology of IBS, the role of intestinal microenvironment factors in symptom development has become more apparent. This review aims to delve into the changes in the composition and structure of the gut microbiome in individuals with IBS. It explores how diet-mediated alterations in intestinal microbes and their byproducts play a role in regulating the pathogenesis of IBS by influencing the "brain-gut" axis, intestinal barrier function, immune responses, and more. By doing so, this review seeks to lay a theoretical foundation for advancing the development of clinical therapeutics for IBS.

Prevalence and Associated Factors of Irritable Bowel Syndrome among Medical Students at King Khalid University.

The stressful life of medical students might induce or exacerbate irritable bowel syndrome (IBS) symptoms. The purpose of this study was to determine the prevalence and related factors of IBS among medical students at King Khalid University (KKU), Saudi Arabia. A descriptive cross-sectional study was conducted among medical students at the KKU. The data collection period was from January to February 2018. Stratified sampling technique was used that included medical students from the second to the sixth year, using self-administered questionnaires contain socio-demographics, medical history, Rome criteria IV, and a personality scale of manifest anxiety. The intended participants were 400 medical students (100%) with 363 (90%) respondents. The mean age was 22 ± 1.6 years; there were 52.9% males and 47.1% females. The prevalence rate of IBS according to the Rome IV criteria was 10.7%. Regarding diagnostic criteria for IBS subtypes, 23.1% represented for both IBS with predominant constipation and IBS with predominant diarrhea, IBS with mixed bowel habits, both diarrhea and constipation, are the higher percentage (43.6%), and IBS unclassified subtype represented by 10.3%. Chi-square test showed high correlation between age and smoking and body mass index (P = 0.04 and 0.05, respectively). Further, there is a significant relationship between IBS and anxiety level (P = 0.04). No gender difference was noted. The prevalence of IBS among medical students at KKU was highest in the age group of 21-23 years, who were nonsmokers, and who had a relatively high grade point average. We did not find a gender difference. Compared to non-IBS students, the anxiety level of the students with IBS was dramatically higher.

EFFECTS OF MODERATE-INTENSITY WEIGHT TRAINING VS. HOME TRAINING ON QUALITY OF LIFE IN NON-ATHLETE MALE PATIENTS WITH IRRITABLE BOWEL SYNDROME

Irritable bowel syndrome (IBS) is a common condition that affects many individuals worldwide and is diagnosed by various accompanying symptoms. Its treatment focuses on alleviating and reducing the severity of symptoms, with exercise being one of the suggested treatments. This study aims to determine the effect of moderate-intensity weight training (MIWT) and home training (HT) on quality of life in non-athletic males with IBS. The sample included 16 non-athletic Algerian males who were diagnosed with irritable bowel syndrome using the Rome III criteria. They were randomly divided into two groups: MIWT group (n = 8) and HT group (n = 8). Each group practiced their training three times a week for 35-40 minutes per session over 8 weeks. The IBS Quality of Life Questionnaire (IBS-QOL) was used to collect data. Both t-test and two-way ANOVA were used for statistical analysis. Study results showed an improvement in quality of life in all domains of IBS- QOL (total score; dysphoria; activity interference; body image; health anxiety; food avoidance; social reactivity; sexual; relationships) for both groups (p < .05). Only one interference with activity showed greater improvement in the MIWT group compared to the HT group (p<.05). Both MIWT and HT contribute to improved quality of life in non-athlete males with IBS, with a superiority of MIWT over HT in the variable interference with activity only. Therefore, researchers recommend using both methods to alleviate the symptoms of IBS.

Exploring congenital sucrase-isomaltase deficiency in autism spectrum disorder patients with irritable bowel syndrome symptoms: A prospective SI gene sequencing study.

Congenital sucrase-isomaltase deficiency (CSID) is an inherited metabolic disorder causing chronic gastrointestinal symptoms and malnutrition when untreated. Most CSID patients are likely to remain under- or misdiagnosed. This study aimed to investigate prevalence of CSID among patients with autism spectrum disorder (ASD) presenting with irritable bowel syndrome (IBS) symptoms via prospective SI gene sequencing. A prospective cross-sectional study was conducted on 98 ASD patients exhibiting gastrointestinal symptoms consistent with IBS. Participants were assessed according to Rome IV criteria and underwent SI gene sequencing. Demographic, clinical, and dietary data were collected and analyzed. Sucrose content in various fruits and vegetables was evaluated using three-day food record, and gastrointestinal symptoms were rated on Likert scale. Seven patients (7%) were diagnosed with CSID based on SI gene analysis, revealing six different variants, including four novel mutations. One patient was homozygous for one variant, and six patients were heterozygous. Clinical presentations predominantly included diarrhea, abdominal pain, and bloating, with two patients showing growth retardation. One patient was diagnosed in adulthood. Food allergy and lactose intolerance were the misdiagnoses prior to CSID diagnosis in two patients. Real prevalence of CSID is likely underestimated. Clinical heterogeneity and non-specific symptoms contribute to diagnostic challenges. Gastrointestinal symptoms consistent with IBS in ASD patients should include CSID in differential diagnosis. Early genetic screening for SI variants in ASD patients with IBS symptoms can facilitate timely diagnosis and management, improving outcomes. Heterozygous variants of the SI gene should also be considered, as heterozygous patients can exhibit typical CSID symptoms.

Serotoninergic Mechanisms of Action in the Relaxant Properties of Saccharomyces boulardii CNCM I-745 on the Intestine.

Perturbations of intestinal serotonergic neurotransmission seem to be involved in bowel dysmotility associated with irritable bowel syndrome (IBS) with diarrhea. Oral administration of probiotics is an emerging strategy to improve IBS symptoms, possibly via influencing local serotonin metabolism and neurotransmission. In the present study, we evaluated the effects of the yeast Saccharomyces boulardii CNCM I-745 (S. boulardii) on intestinal motility and serotonergic receptors. Isolated rat ileum was contracted in a cumulative concentration way by serotonin (5-HT), various 5-HT agonists or by acetylcholine to determine their effective concentration 50% (EC50). Single concentrations of S. boulardii or 5-HT antagonists were added before agonists to identify the receptors targeted by S. boulardii. The serotonin antagonists 5-HT1A WAY100635, 5-HT2A ketanserin and 5-HT4 GR113808 inhibited 5-HT-induced contractions in a concentration-dependent manner. S. boulardii between 0.05 and 1.5mg/mL increased the EC50 value of 5-HT suggesting an inhibitory effect against serotonin-induced contraction. Ileum contractions induced by the serotonin agonist 5-HT1 carboxamidotryptamine or by the serotonin agonist 5-HT2 alpha-methyl-5-HT were significantly reduced by S. boulardii at 1.5mg/mL. The yeast did not affect acetylcholine-induced ileum contraction. S. boulardii CNCM I-745 possesses relaxant properties on the rat ileum involving the inhibition of 5-HT and more specifically 5-HT1A and 5-HT2A/2B/2C receptor-induced contractions. These data suggest that the attenuation of 5-HT-induced ileal contractions by S. boulardii represents a probable mechanism of action sustaining its efficacy in patients affected by IBS with diarrhea.

Efficacy of Dietary Interventions for Irritable Bowel Syndrome: A Systematic Review and Network Meta-Analysis

Introduction: Irritable bowel syndrome (IBS) is a common condition that alters the quality of life of patients. A variety of dietary interventions have been introduced to address this debilitating condition. The low-FODMAP diet (LFD), gluten-free diet (GFD), and Mediterranean diet are examples showing efficacy. The aim of this network meta-analysis was to compare these interventions to find the best approach. Methods: We performed a systematic review of the available literature through 14 March 2024 in the following databases: Embase, PubMed, MEDLINE OVID, Web of Science, CINAHL Plus, and Cochrane Central. We only included randomized controlled trials (RCTs). We used a random effects model and conducted a direct meta-analysis based on the DerSimonian–Laird approach and a network meta-analysis based on the frequentist approach. Mean differences (MDs) with 95% confidence interval (CI) were calculated. The primary outcomes included IBS quality of life (IBS QOL) and IBS symptom severity scale (IBS-SSS). Results: We finalized 23 studies including 1689 IBS patients. In the direct meta-analysis, there was no statistically significant difference in any IBS score between GFD and either LFD or standard diet. Meanwhile, the LFD was statistically superior to the standard diet in the IBS-SSS (MD: −46.29, CI: −63.72–−28.86, p < 0.01) and IBS QOL (MD: 4.06, CI: 0.72–7.41, p = 0.02). On ranking, the Mediterranean diet showed the greatest improvement in IBS-SSS, IBS-QOL, distension, dissatisfaction, and general life interference, followed by the LFD alone or in combination with the GFD. Conclusions: We demonstrated the efficacy of dietary interventions such as the LFD and Mediterranean diet in improving IBS. There is a need for large RCTs with head-to-head comparisons, particularly for the Mediterranean diet.

Rifaximin-Alpha Increases Lactase Activity in Patients with Irritable Bowel Syndrome Without Constipation and Small Intestinal Bacterial Overgrowth.

Irritable bowel syndrome symptoms are associated with diverse pathophysiological mechanisms including small intestinal bacterial overgrowth and food intolerance. Small intestinal bacterial overgrowth leads to the decreased activity of several digestive enzymes, including lactase. To assess the efficacy of rifaximin-alpha on the symptoms and lactase activity of patients with irritable bowel syndrome without constipation. This was a prospective, pilot study. The recruited patients had irritable bowel syndrome without constipation (Rome IV criteria), a positive lactulose-Hydrogen Breath Test for small intestinal bacterial overgrowth, low urinary D-Xylose levels measured using the Lactest® test, and self-reported lactose intolerance. In addition, lactose HBT was performed. All patients received 400mg rifaximin-alpha every 8h for 2weeks. Four weeks after the intervention, lactose and lactulose HBT were performed, and the symptoms and urinary D-Xylose levels were evaluated. After treatment with rifaximin-alpha, 60% of the patients reported improvement in abdominal pain, 44% in bloating, 36% in flatulence, 60% in borborygmi, and 72% in stool consistency. A negative lactulose-Hydrogen Breath Test result for SIBO was documented in 32% of patients, and lactose maldigestion by lactose-Hydrogen Breath Test was reduced from 88 to 52% of the studied subjects. The median D-Xylose levels before and after treatment were 7.6 (IQR 4.34-13.7)mg/dL vs. 10.4 (IQR 7.1-17.3)mg/dL, p = 0.002. Rifaximin-alpha caused symptomatic improvement, reduced lactose maldigestion, and reduced positive Hydrogen Breath Test results for small intestinal bacterial overgrowth in patients with irritable bowel syndrome without constipation.

Effects of Bifidobacterium longum longum 35624® on the Symptoms and Quality of Life in Patients with Irritable Bowel Syndrome: Results of the Multicenter Observational Program SAGA

Aim: to evaluate the effects of the probiotic Symbiosys Alflorex (Bifidobacterium longum longum 35624®) on the symptoms and quality of life in patients with irritable bowel syndrome (IBS).Materials and methods. A multicenter, observational program (SAGA) was conducted to evaluate the effects of Symbiosys Alflorex on symptoms and quality of life in patients with IBS, which enrolled 3,116 patients and 246 physicians from 48 cities of Russia. Eligible patients were diagnosed with IBS according to the Rome IV Criteria and clinical guidelines of the Russian Association of Gastroenterology and the Association of Colorectal Surgeons of Russia. Patients received standard-of-care treatment and add-on therapy with Symbiosys Alflorex 1 capsule once daily for 28 days, followed by Symbiosys Alflorex alone for 2 months. The intensity of symptoms and severity of IBS were assessed using the 7 Symptoms in 7 Days (“7 × 7”) and the Irritable Bowel Syndrome Severity Scoring System (IBS-SSS) questionnaires, respectively. The Irritable Bowel Syndrome Quality of Life (IBS-QоL) questionnaire was used to assess the quality of life. Stool abnormalities were assessed using the Bristol Stool Scale.Results. After the course of standard-of-care treatment and add-on therapy with Symbiosys Alflorex, 25.8 % of patients achieved clinical remission. After 3 months of probiotic treatment, 76.9 % of patients achieved clinical remission. A significant decrease in the “7 × 7” score was observed, with the mean total score decreasing from 15.8 to 9.77 after the main treatment course and to 3.44 by the end of the study. Stool consistency became normal in 40.1 % of patients by the end of the first month and in 76.8 % after 3 months of follow-up. Changes in the IBS-QoL score showed a significant improvement in the quality of life.Conclusions. Add-on treatment with Symbiosys Alflorex 1 capsule once daily for 3 months helps to improve IBS symptoms and quality of life of patients. Symbiosys Alflorex has a favorable safety profile.

Alterations of fractional anisotropy and white matter integrity in irritable bowel syndrome: a systematic review and meta-analysis of diffusion tensor imaging studies.

The neurological processes responsible for irritable bowel syndrome (IBS) pathophysiology and its clinical potentials are not fully understood. The current study aimed to examine white matter microstructural abnormalities and the reasons behind white matter impairment in individuals with irritable bowel syndrome by performing a meta-analysis of diffusion tensor imaging studies. PubMed, Scopus and Web of Science were searched until April 2024. Chosen articles based on our defined eligibility criteria were extracted for the data relating to fractional anisotropy and brain connectivity. Webplot digitizer was used to extract digital data. We used the latest version of STATA(ver18) to meta-analyze the data. Quality assessment of studies was done using a critical appraisal tool. Egger's test for minor study effects assessed the publication bias. 543 IBS cases and 472 healthy controls were included in this study. The mean age of the case and control group was 35.2 ± 17.4 and 33.6 ± 15.8 (mean ± SD), respectively. There was no statistically significant difference in age between groups (p > 0.05). Analyzed Standard mean difference using a fixed model for Fractional anisotropy of regions of interest (ROI) associated with sensory processing, such as the thalamus, insula, primary somatosensory cortex, dorsal cingulum and the fornix in selected studies showcased decreased white matter interactivity in case group however this decrease was not statistically different [SMD -88, 95%CI (-1.32, -0.44), p > 0.05]. Further investigation is necessary to ascertain whether the modified structural connectivity mentioned in this study is a contributing factor to IBS, an outcome of the condition, a risk factor for it, or, more probably, a consequence of a mutually influential relationship between the changes observed in the white matter tract and IBS symptoms.

Dietary Intake and Quality in Irritable Bowel Syndrome: A Comparative Study With Controls and the Association With Symptom Severity.

Patients with irritable bowel syndrome (IBS) often attribute the onset or worsening of gastrointestinal symptoms to intake of food. Hence, to alleviate symptoms, patients with IBS may avoid triggering foods, potentially impacting their dietary intake and diet quality. This study aimed to compare the habitual diet intake and quality of patients with IBS with controls and to explore the association between dietary habits and symptoms in patients with IBS. Patients with IBS were included in 4 clinical studies reporting habitual dietary intakes at baseline. Age- and sex-matched controls representing the general population were derived from the Swedish population-based Riksmaten study. Dietary intakes were assessed using 4-day food diaries. Diet quality was measured using the diet quality index-Swedish national dietary guidelines (DQI-SNR), and diet diversity was scored based on the variety of food groups consumed. The study included 646 patients with IBS and 646 controls (38 ± 14 years, 77% female). Both groups adhered to Nordic nutrition recommendations for macronutrients, except patients consumed fewer carbohydrates. Patients reported eating less carbohydrates, coffee, and dairy products and more fats, lactose-free dairy products, and nuts and seeds compared with controls. Fewer patients had a good diet quality according to the DQI-SNR. In patients, symptom severity and gastrointestinal-specific anxiety were associated with reduced energy and carbohydrate intake, lower diet diversity, and worse diet quality. Poor diet quality was associated with younger age, more severe IBS symptoms, anxiety, and depression. Patients with IBS exhibit different dietary patterns compared with controls, with poorer dietary habits linked to more severe symptoms. Understanding food-symptom associations may enhance the optimization and personalization of dietary management for patients with IBS.

Targeting the Microbiome: The Role of Low-FODMAP Diet in Modulating Gut Health for IBS and Inflammatory Conditions

The Low-FODMAP diet has emerged as a key therapeutic intervention for managing irritable bowel syndrome (IBS), a prevalent gastrointestinal disorder characterized by recurrent abdominal pain and altered bowel habits. This study aims to evaluate the efficacy of the Low-FODMAP diet in alleviating IBS symptoms and to explore its potential as a broader therapeutic tool in other gastrointestinal disorders, including inflammatory conditions. Our review highlights significant improvements in symptom relief, notably in reducing bloating, pain, and bowel irregularities, which are commonly associated with IBS. The Low-FODMAP diet’s mechanisms of action, involving modulation of gut microbiota and reduction of osmotic effects, provide new insights into its impact on gastrointestinal health.Our findings underscore the Low-FODMAP diet’s potential applications beyond IBS, suggesting benefits in conditions such as inflammatory bowel disease (IBD) and small intestinal bacterial overgrowth (SIBO). However, the long-term impacts of this diet on gut microbiota composition, mental health, and immune function require further investigation. Future research should focus on these aspects, especially in relation to diet sustainability and microbial diversity. The clinical implications of this study encourage healthcare providers to consider the Low-FODMAP diet as a personalized, non-pharmacological option for gastrointestinal symptom management, with careful monitoring to ensure nutritional adequacy and individual patient needs.

Effects of a Protease Inhibitor Camostat Mesilate on Gut Microbial Function in Patients with Irritable Bowel Syndrome: A Pilot Randomized Placebo-Controlled Study

Introduction: Increased fecal protease activity, which may induce visceral hypersensitivity, has been observed in patients with irritable bowel syndrome (IBS). Serine proteases modulate FK506 binding protein (FKBP)-type peptidylprolyl cis-trans isomerase (PPIase) activity associated with immune and glucocorticoid receptor functions. The aim was to investigate whether camostat mesilate (CM), a serine protease inhibitor, modifies fecal bacterial function related to FKBP-type PPIases in patients with IBS. Methods: Randomly assigned 16 patients with IBS received 200 mg po tid of CM and 16 patients received placebo for 14 days. Self-reported adequate relief (AR) as a primary endpoint, IBS Symptom Severity Scale (IBS-SSS), and colonic motor and pain thresholds to colorectal distention were assessed before and after treatment. The fecal bacterial content was inferred from 16S rRNA gene sequence data using Phylogenetic Investigation of Communities by Reconstruction of Unobserved States and the Kyoto Encyclopedia of Genes and Genomes database. Results: CM significantly increased the relative abundance of Streptococcus and the functional abundances of serine protease and FKBP-type PPIase FkpA, FklB and SlyD more than placebo after treatment. CM treatment was not superior to placebo in proportion of AR although colonic motor response partially changed. Conclusion: CM modulated the fecal microbiome composition and functional potentials that are related to FKBP-type PPIase activity in IBS patients. These findings suggest that protease inhibitors may modify gut microbial function along with abnormal immunological and/or stress responses that underlie pathophysiology of IBS.

The Role of the Gut Microbiota in Individuals with Irritable Bowel Syndrome: A Scoping Review.

Irritable bowel syndrome (IBS) represents the most prevalent disorder of brain-gut interaction, affecting approximately 10% of the global population. The objective of this study was to examine the mechanisms by which the gut microbiota contributes to the development of IBS. To this end, a review of articles that examined the gut microbiota of IBS patients was conducted. A search was conducted using PubMed and J-STAGE for articles published over the past five years that relate to the gut microbiota in patients with IBS. Individuals diagnosed with IBS display a reduction in alpha diversity and a decline in butyrate-producing bacteria, which collectively indicate a state of dysbiosis within their gut microbiota. Butyrate plays a dual role in the body, acting as a source of nutrition for the intestinal epithelium while also regulating the expression of dopamine transporters and D2 receptors in the central nervous system through epigenetic mechanisms. These characteristics may be linked to dysfunction of the central dopamine D2 pathway and play a role in the formation of various symptoms in IBS.