Irritable bowel syndrome: new insights into symptom mechanisms and advances in treatment

Spiller, Robin C.

doi:10.12688/f1000research.7992.1

Cited by 37 publications

(34 citation statements)

References 76 publications

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“…96,97 Still, RCTs are needed to prove whether the FOD-MAP diet is superior to other dietary interventions (e.g.,, lactose or fructose reduction) or general dietary advice (e.g., the NICE guidelines). 98 Finally, the FODMAP levels vary between studies, countries, and products, which should be taken into account when interpreting study results and recommending low-FODMAP diets.…”

Section: Diet and Ibsmentioning

confidence: 99%

“…Ten% of IBS-D patients have severe BA malabsorption and as many as 25-50% of patients show evidence of some degree of BA malabsorption. 97,99 BA are produced from cholesterol in hepatocytes with cholic acid and chenodeoxycholic acid is the primary BA. In the liver >90% of BA are conjugated with taurine or glycine to increase solubility and inpermeability critical for the formation of micelles surrounding insoluble fatty acids and monoglycerides.…”

Section: Bile Acids and Ibsmentioning

confidence: 99%

“…97 With the reuptake of BA in the ileum the nuclear receptor Farnesoid X receptor (FXR), expressed in enterocytes and in hepatocytes, stimulates the production of FGF19 and release it into the portal circulation. FGF19 inhibits cholesterol 7-hydroxylase and the formation of primary BA.…”

Section: Bile Acids and Ibsmentioning

confidence: 99%

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Irritable bowel syndrome, the microbiota and the gut-brain axis

Raskov¹,

et al. 2016

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Irritable bowel syndrome is a common functional gastrointestinal disorder and it is now evident that irritable bowel syndrome is a multi-factorial complex of changes in microbiota and immunology. The bidirectional neurohumoral integrated communication between the microbiota and the autonomous nervous system is called the gut-brain-axis, which integrates brain and GI functions, such as gut motility, appetite and weight. The gut-brain-axis has a central function in the perpetuation of irritable bowel syndrome and the microbiota plays a critical role. The purpose of this article is to review recent research concerning the epidemiology of irritable bowel syndrome, influence of microbiota, probiota, gut-brainaxis, and possible treatment modalities on irritable bowel syndrome. The integrated actions and communication between the microbiota and the autonomous nervous system are central players in the perpetuation of IBS symptoms. This signaling pathway is called the GutBrain Axis (GBA). The GBA is a bidirectional neurohumoral communication system that integrates brain and GI functions, such as gut motility, appetite and weightand here the microbiota plays a critical role. 2Changes in gastrointestinal or central nervous system physiology may result in an altered habitat, which again may cause changes in the composition of the microbiota.Disruption of the physiologic symbiotic relationship (eubiosis) between the human host and the microbiota is called dysbiosis and is regarded a basic factor for initiating and maintaining IBS in the majority of patients. Current evidence has suggested that the dysbiosis observed in IBS and the resulting immunological response may drive and perpetuate gastrointestinal symptoms of IBS suggesting that IBS is in fact a disorder of the microbiota and the GBA. It is unclear whether the initiating factor is brain abnormalities that drive the gut changes or if changes in the gut alter brain function through vagal and sympathetic pathways.3,4 The purpose of this article is to review recent research concerning the influence of microbiota and gut-brain-axis on IBS. IBSIt is estimated that approximately 10% of the World population and 15% of the population in the Western World suffer from IBS characterized by a mixture of recurrent abdominal pain, bloating, changing stool consistency such as diarrhea (IBS-D), constipation (IBS-C), or interchanging diarrhea and constipation (mixed-type or IBS-M), mucus secretion, and nausea. 5,6 Community-based data indicate that IBS-M is the most prevalent type followed by IBS-D and IBS-C and that switching among subtypes occurs. Bloating is the most prevalent symptom reported by 96% of patients with IBS of whatever subgroup. 7 In addition to abdominal symptoms, poor sleep, headache, CONTACT Hans Raskov raskov@mail.dk Lundevangsvej 23, DK-2900 Hellerup, Denmark. Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/kgmi.

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Section: Diet and Ibsmentioning

confidence: 99%

Section: Bile Acids and Ibsmentioning

confidence: 99%

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Irritable bowel syndrome, the microbiota and the gut-brain axis

Raskov¹,

et al. 2016

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“…Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder that presents with abdominal pain and further symptoms that are diarrhea predominant (IBS-D) or constipation predominant (IBS-C) [39,40] . The pathophysiology of IBS is complex and involves psychosocial factors, gut-brain dysfunction and alterations in gastrointestinal motility and permeability [41,42] .…”

Section: Irritable Bowel Syndrome and Diarrheamentioning

confidence: 99%

Disease-Associated Changes in Bile Acid Profiles and Links to Altered Gut Microbiota

Joyce

Gahan²

2017

Dig Dis

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The gastrointestinal microbiota plays a central role in the host metabolism of bile acids through deconjugation and dehydroxylation reactions, which generate unconjugated free bile acids and secondary bile acids respectively. These microbially generated bile acids are particularly potent signalling molecules that interact with host bile acid receptors (including the farnesoid X receptor, vitamin D receptor and TGR5 receptor) to trigger cellular responses that play essential roles in host lipid metabolism, electrolyte transport and immune regulation. Perturbations of microbial populations in the gut can therefore profoundly alter bile acid profiles in the host to impact upon the digestive and signalling properties of bile acids in the human superorganism. A number of recent studies have clearly demonstrated the occurrence of microbial disturbances allied to alterations in host bile acid profiles that occur across a range of disease states. Intestinal diseases including irritable bowel syndrome, inflammatory bowel disease (IBD), short bowel syndrome and Clostridium difficile infection all exhibit concurrent alterations in the composition of the gut microbiota and changes to host bile acid profiles. Similarly, extraintestinal diseases and syndromes such as asthma and obesity may be linked to aberrant bile acid profiles in the host. Here, we focus upon recent studies that highlight the links between alterations to gut microbial communities and altered bile acid profiles across a range of diseases from asthma to IBD.

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“…Recent observations of the pathophysiology of IBS suggest various causes for the symptoms 3 . Mounting evidence points to the presence of inflammation in the intestinal lining and proinflammatory mediators in the bloodstream in many individuals with IBS symptoms 4,5,6 .…”

Section: Featured Articlementioning

confidence: 99%