Rheumatology International

, Volume 35, Issue 3, pp 433–444

An insight into the gastrointestinal component of fibromyalgia: clinical manifestations and potential underlying mechanisms

  • Mahmoud Slim
  • Elena Pita Calandre
  • Fernando Rico-Villademoros
Review Article - Pathology Review

Abstract

Fibromyalgia syndrome is characterized by chronic generalized pain accompanied by a broad symptomatologic spectrum. Besides chronic fatigue, sleep disturbances, headaches and cognitive dysfunction that are extensively described in the literature, a considerable proportion of patients with fibromyalgia experience gastrointestinal symptoms that are commonly overlooked in the studies that are not specifically dedicated to evaluate these manifestations. Nevertheless, various attempts were undertaken to explore the gastrointestinal dimension of fibromyalgia. Several studies have demonstrated an elevated comorbidity of irritable bowel syndrome (IBS) among patients with fibromyalgia. Other studies have investigated the frequency of presentation of gastrointestinal symptoms in fibromyalgia in a nonspecific approach describing several gastrointestinal complaints frequently reported by these patients such as abdominal pain, dyspepsia and bowel changes, among others. Several underlying mechanisms that require further investigation could serve as potential explanatory hypotheses for the appearance of such manifestations. These include sensitivity to dietary constituents such as gluten, lactose or FODMAPs or alterations in the brain–gut axis as a result of small intestinal bacterial overgrowth or subclinical enteric infections such as giardiasis. The gastrointestinal component of fibromyalgia constitutes a relevant element of the multidisciplinary pathophysiologic mechanisms underlying fibromyalgia that need to be unveiled, as this would contribute to the adequate designation of relevant treatment alternatives corresponding to these manifestations.

Keywords

Fibromyalgia Gastrointestinal symptoms Food hypersensitivity Brain–gut axis alterations 

References

  1. 1.
    Smith HS, Harris R, Clauw D (2011) Fibromyalgia: an afferent processing disorder leading to a complex pain generalized syndrome. Pain Physician 14(2):E217–E245PubMedGoogle Scholar
  2. 2.
    Arnold LM, Clauw DJ, McCarberg BH, FibroCollaborative (2011) Improving the recognition and diagnosis of fibromyalgia. Mayo Clin Proc 86(5):457–464PubMedCentralPubMedGoogle Scholar
  3. 3.
    Bennett RM (2009) Clinical manifestations and diagnosis of fibromyalgia. Rheum Dis Clin North Am 35(2):215–232PubMedGoogle Scholar
  4. 4.
    Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL et al (1990) The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum 33(2):160–172PubMedGoogle Scholar
  5. 5.
    Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P et al (2010) The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res 62(5):600–610Google Scholar
  6. 6.
    Sommer C, Häuser W, Burgmer M, Engelhardt R, Gerhold K, Petzke F et al (2012) Etiology and pathophysiology of fibromyalgia syndrome. Schmerz 26(3):259–267PubMedGoogle Scholar
  7. 7.
    Buskila D, Sarzi-Puttini P (2006) Biology and therapy of fibromyalgia. Genetic aspects of fibromyalgia syndrome. Arthritis Res Ther 8(5):218PubMedCentralPubMedGoogle Scholar
  8. 8.
    Bradley LA (2008) Pathophysiologic mechanisms of fibromyalgia and its related disorders. J Clin Psychiatry 69(Suppl 2):6–13PubMedGoogle Scholar
  9. 9.
    Buskila D, Atzeni F, Sarzi-Puttini P (2008) Etiology of fibromyalgia: the possible role of infection and vaccination. Autoimmun Rev 8(1):41–43PubMedGoogle Scholar
  10. 10.
    Maquet D, Croisier JL, Demoulin C, Crielaard JM (2004) Pressure pain thresholds of tender point sites in patients with fibromyalgia and in healthy controls. Eur J Pain 8(2):111–117PubMedGoogle Scholar
  11. 11.
    Julien N, Goffaux P, Arsenault P, Marchand S (2005) Widespread pain in fibromyalgia is related to a deficit of endogenous pain inhibition. Pain 114(1–2):295–302PubMedGoogle Scholar
  12. 12.
    Nielsen LA, Henriksson KG (2007) Pathophysiological mechanisms in chronic musculoskeletal pain (fibromyalgia): the role of central and peripheral sensitization and pain disinhibition. Best Pract Res Clin Rheumatol 21(3):465–480PubMedGoogle Scholar
  13. 13.
    Adler GK, Manfredsdottir VF, Creskoff KW (2002) Neuroendocrine abnormalities in fibromyalgia. Curr Pain Headache Rep 6(4):289–298PubMedGoogle Scholar
  14. 14.
    Yunus MB (2007) Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes. Semin Arthritis Rheum 36(6):339–356PubMedGoogle Scholar
  15. 15.
    Barsky AJ, Borus JF (1999) Functional somatic syndromes. Ann Intern Med 130(11):910–921PubMedGoogle Scholar
  16. 16.
    Sharpe M (2002) Medically unexplained symptoms and syndromes. Clin Med 2(6):501–504PubMedGoogle Scholar
  17. 17.
    Woolf CJ (2011) Central sensitization: implications for the diagnosis and treatment of pain. Pain 152(3 Suppl):S2–S15PubMedCentralPubMedGoogle Scholar
  18. 18.
    Yunus MB (2012) The prevalence of fibromyalgia in other chronic pain conditions. Pain Res Treat 2012:584573PubMedCentralPubMedGoogle Scholar
  19. 19.
    Weir PT, Harlan GA, Nkoy FL, Jones SS, Hegmann KT, Gren LH et al (2006) The incidence of fibromyalgia and its associated comorbidities: a population-based retrospective cohort study based on International Classification of Diseases, 9th Revision codes. J Clin Rheumatol 12(3):124–128PubMedGoogle Scholar
  20. 20.
    Yunus M, Masi AT, Calabro JJ, Miller KA, Feigenbaum SL (1981) Primary fibromyalgia (fibrositis): clinical study of 50 patients with matched normal controls. Semin Arthritis Rheum 11(1):151–171PubMedGoogle Scholar
  21. 21.
    Campbell SM, Clark S, Tindall EA, Forehand ME, Bennett RM (1983) Clinical characteristics of fibrositis. I. A “blinded,” controlled study of symptoms and tender points. Arthritis Rheum 26(7):817–824PubMedGoogle Scholar
  22. 22.
    Bengtsson A, Henriksson KG, Jorfeldt L, Kågedal B, Lennmarken C, Lindström F (1986) Primary fibromyalgia. A clinical and laboratory study of 55 patients. Scand J Rheum 15(3):340–347PubMedGoogle Scholar
  23. 23.
    Goldenberg DL (1987) Fibromyalgia syndrome. An emerging but controversial condition. JAMA 257(20):2782–2787PubMedGoogle Scholar
  24. 24.
    Romano TJ (1988) Coexistence of irritable bowel syndrome and fibromyalgia. W V Med J 84(2):16–18PubMedGoogle Scholar
  25. 25.
    Veale D, Kavanagh G, Fielding JF, Fitzgerald O (1991) Primary fibromyalgia and the irritable bowel syndrome: different expressions of a common pathogenetic process. Br J Rheumatol 30(3):220–222PubMedGoogle Scholar
  26. 26.
    Hudson JI, Goldenberg DL, Pope HG Jr, Keck PE Jr, Schlesinger L (1992) Comorbidity of fibromyalgia with medical and psychiatric disorders. Am J Med 92(4):363–367PubMedGoogle Scholar
  27. 27.
    Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L (1995) The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum 38(1):19–28PubMedGoogle Scholar
  28. 28.
    Sivri A, Cindaş A, Dinçer F, Sivri B (1996) Bowel dysfunction and irritable bowel syndrome in fibromyalgia patients. Clin Rheumatol 15(3):283–286PubMedGoogle Scholar
  29. 29.
    Sperber AD, Atzmon Y, Neumann L, Weisberg I, Shalit Y, Abu-Shakrah M et al (1999) Fibromyalgia in the irritable bowel syndrome: studies of prevalence and clinical implications. Am J Gastroenterol 94(12):3541–3546PubMedGoogle Scholar
  30. 30.
    Aaron LA, Burke MM, Buchwald D (2000) Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder. Arch Intern Med 160(2):221–227PubMedGoogle Scholar
  31. 31.
    Lubrano E, Iovino P, Tremolaterra F, Parsons WJ, Ciacci C, Mazzacca G (2001) Fibromyalgia in patients with irritable bowel syndrome. An association with the severity of the intestinal disorder. Int J Colorectal Dis 16(4):211–215PubMedGoogle Scholar
  32. 32.
    Kurland JE, Coyle WJ, Winkler A, Zable E (2006) Prevalence of irritable bowel syndrome and depression in fibromyalgia. Dig Dis Sci 51(3):454–460PubMedGoogle Scholar
  33. 33.
    Cole JA, Rothman KJ, Cabral HJ, Zhang Y, Farraye FA (2006) Migraine, fibromyalgia, and depression among people with IBS: a prevalence study. BMC Gastroenterol 6:26PubMedCentralPubMedGoogle Scholar
  34. 34.
    Pamuk ON, Umit H, Harmandar O (2009) Increased frequency of gastrointestinal symptoms in patients with fibromyalgia and associated factors: a comparative study. J Rheumatol 36(8):1720–1724PubMedGoogle Scholar
  35. 35.
    Triadafilopoulos G, Simms RW, Goldenberg DL (1991) Bowel dysfunction in fibromyalgia syndrome. Dig Dis Sci 36(1):59–64PubMedGoogle Scholar
  36. 36.
    Tüzün EH, Albayrak G, Eker L, Sözay S, Daşkapan A (2004) A comparison study of quality of life in women with fibromyalgia and myofascial pain syndrome. Disabil Rehabil 26(4):198–202PubMedGoogle Scholar
  37. 37.
    Almansa C, Rey E, Sánchez RG, Sánchez AA, Díaz-Rubio M (2009) Prevalence of functional gastrointestinal disorders in patients with fibromyalgia and the role of psychologic distress. Clin Gastroenterol Hepatol 7(4):438–445PubMedGoogle Scholar
  38. 38.
    Smythe HA (1972) Non-articular rheumatism and psychogenie musculoskeletal syndromes. In: Hollander JL, McCarty DJ (eds) Arthritis and allied conditions, 8th edn. Lea and Febiger, Philadelphia, pp 874–884Google Scholar
  39. 39.
    Kruis W, Thieme C, Weinzierl M, Schüssler P, Holl J, Paulus W (1984) A diagnostic score for the irritable bowel syndrome. Its value in the exclusion of organic disease. Gastroenterology 87(1):1–7PubMedGoogle Scholar
  40. 40.
    Smythe HA (1985) Non-articular rheumatism and psychogenie musculoskeletal syndromes. In: Hollander JL, McCarty DJ (eds) Arthritis and allied conditions, 10th edn. Lea and Febiger, Philadelphia, pp 1083–1094Google Scholar
  41. 41.
    Pope HG Jr, Hudson JI (1991) A supplemental interview for forms of “affective spectrum disorder”. Int J Psychiatry Med 21(3):205–232PubMedGoogle Scholar
  42. 42.
    Drossman DA, Sandler RS, McKee DC, Lovits AJ (1982) Bowel patterns among subjects not seeking health care. Use of a questionnaire to identify a population with bowel dysfunction. Gastroenterology 83(3):529–534PubMedGoogle Scholar
  43. 43.
    Thompson WG, Creed FH, Drossman DA, Heaton KW, Mazzacca G (1992) Functional bowel disorders and functional abdominal pain. Gastroenterol Int 5:75–91Google Scholar
  44. 44.
    Manning AP, Thompson WG, Heaton KW, Morris AF (1978) Towards positive diagnosis of the irritable bowel. Br Med J 2(6138):653–654PubMedCentralPubMedGoogle Scholar
  45. 45.
    Drossman DA, Thompson GW, Talley NJ, Funche-Jensen P, Whitehead WE (1990) Identification of subgroups of functional gastrointestinal disorders. Gastroenterol Int 3:159–172Google Scholar
  46. 46.
    Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA (1999) Functional bowel disorders and functional abdominal pain. Gut 45(Suppl 2):II43–II47PubMedCentralPubMedGoogle Scholar
  47. 47.
    Smythe H (1986) Tender points: evolution of concepts of fibrositis/fibromyalgia syndrome. Am J Med 81(suppl 3A):2–6PubMedGoogle Scholar
  48. 48.
    Drossman DA, Corazziari E, Talley NJ, Thompson WG, Whitehead WE (eds) (2000) The functional gastrointestinal disorders, 2nd edn. Degnon Associates, McLean, VA, pp 690–714, Appendix CGoogle Scholar
  49. 49.
    Queiroz LP (2013) Worldwide epidemiology of fibromyalgia. Curr Pain Headache Rep 17(8):356PubMedGoogle Scholar
  50. 50.
    Adeyemo MA, Spiegel BM, Chang L (2010) Meta-analysis: do irritable bowel syndrome symptoms vary between men and women? Aliment Pharmacol Ther 32(6):738–755PubMedCentralPubMedGoogle Scholar
  51. 51.
    Akkuş S, Senol A, Ayvacioglu NB, Tunc E, Eren I, Isler M (2004) Is female predominance in irritable bowel syndrome related to fibromyalgia? Rheumatol Int 24(2):106–109PubMedGoogle Scholar
  52. 52.
    Lovell RM, Ford AC (2012) Effect of gender on prevalence of irritable bowel syndrome in the community: systematic review and meta-analysis. Am J Gastroenterol 107(7):991–1000PubMedGoogle Scholar
  53. 53.
    Wolfe F, Brähler E, Hinz A, Häuser W (2013) Fibromyalgia prevalence, somatic symptom reporting, and the dimensionality of polysymptomatic distress: results from a survey of the general population. Arthritis Care Res (Hoboken) 65(5):777–785Google Scholar
  54. 54.
    Chang L (1998) The association of functional gastrointestinal disorders and fibromyalgia. Eur J Surg Suppl 583:32–36PubMedGoogle Scholar
  55. 55.
    Caldarella MP, Giamberardino MA, Sacco F, Affaitati G, Milano A, Lerza R et al (2006) Sensitivity disturbances in patients with irritable bowel syndrome and fibromyalgia. Am J Gastroenterol 101(12):2782–2789PubMedGoogle Scholar
  56. 56.
    Haugen M, Kjeldsen-Kragh J, Nordvåg BY, Førre O (1991) Diet and disease symptoms in rheumatic diseases–results of a questionnaire based survey. Clin Rheumatol 10(4):401–407PubMedGoogle Scholar
  57. 57.
    Arranz LI, Canela MÁ, Rafecas M (2012) Dietary aspects in fibromyalgia patients: results of a survey on food awareness, allergies, and nutritional supplementation. Rheumatol Int 32(9):2615–2621PubMedGoogle Scholar
  58. 58.
    Berstad A, Undseth R, Lind R, Valeur J (2012) Functional bowel symptoms, fibromyalgia and fatigue: a food-induced triad? Scand J Gastroenterol 47(8–9):914–919PubMedCentralPubMedGoogle Scholar
  59. 59.
    Puccio FA, Rojas R, Mosquera I, Hernandez A, Mosquera R, Jaua L et al (2013) Food allergy is an important diseases associated to fibromyalgia. Clin Transl Allergy 3(Suppl 3):120 [abstract]Google Scholar
  60. 60.
    Farrell RJ, Kelly CP (2002) Celiac sprue. N Engl J Med 346(3):180–188PubMedGoogle Scholar
  61. 61.
    Ludvigsson JF, Leffler DA, Bai JC, Biagi F, Fasano A, Green PH et al (2013) The Oslo definitions for coeliac disease and related terms. Gut 62(1):43–52PubMedCentralPubMedGoogle Scholar
  62. 62.
    Lo W, Sano K, Lebwohl B, Diamond B, Green PH (2003) Changing presentation of adult celiac disease. Dig Dis Sci 48(2):395–398PubMedGoogle Scholar
  63. 63.
    Pulido O, Zarkadas M, Dubios S, Macisaac K, Cantin I, La Vieille S et al (2013) Clinical features and symptom recovery on a gluten-free diet in Canadian adults with celiac disease. Can J Gastroenterol 27(8):449–453PubMedCentralPubMedGoogle Scholar
  64. 64.
    Nelsen DA Jr (2002) Gluten-sensitive enteropathy (celiac disease): more common than you think. Am Fam Physician 66(12):2259–2266PubMedGoogle Scholar
  65. 65.
    Rashtak S, Murray JA (2009) Celiac disease in the elderly. Gastroenterol Clin North Am 38(3):433–446PubMedCentralPubMedGoogle Scholar
  66. 66.
    Rubio-Tapia A, Herman ML, Ludvigsson JF, Kelly DG, Mangan TF, Wu TT et al (2012) Severe spruelike enteropathy associated with olmesartan. Mayo Clin Proc 87(8):732–738PubMedCentralPubMedGoogle Scholar
  67. 67.
    Rodrigo L, Blanco I, Bobes J, de Serres FJ (2013) Remarkable prevalence of coeliac disease in patients with irritable bowel syndrome plus fibromyalgia in comparison with those with isolated irritable bowel syndrome: a case-finding study. Arthritis Res Ther 15(6):R201PubMedCentralPubMedGoogle Scholar
  68. 68.
    Rodrigo L, Blanco I, Bobes J, de Serres FJ (2013) Clinical impact of a gluten-free diet on health-related quality of life in seven fibromyalgia syndrome patients with associated celiac disease. BMC Gastroenterol 13:157PubMedCentralPubMedGoogle Scholar
  69. 69.
    Zipser RD, Patel S, Yahya KZ, Baisch DW, Monarch E (2003) Presentations of adult celiac disease in a nationwide patient support group. Dig Dis Sci 48(4):761–764PubMedGoogle Scholar
  70. 70.
    Tovoli F, Giampaolo L, Caio G, Monti M, Piscaglia M, Frisoni M et al (2013) Fibromyalgia and coeliac disease: a media hype or an emerging clinical problem? Clin Exp Rheumatol 31(6 Suppl 79):S50–S52PubMedGoogle Scholar
  71. 71.
    Taubman B, Mamula P, Sherry DD (2011) Prevalence of asymptomatic celiac disease in children with fibromyalgia: a pilot study. Pediatr Rheumatol Online J 9:11PubMedCentralPubMedGoogle Scholar
  72. 72.
    Catassi C, Bai JC, Bonaz B, Bouma G, Calabrò A, Carroccio A et al (2013) Non-Celiac Gluten sensitivity: the new frontier of gluten related disorders. Nutrients 5(10):3839–3853PubMedCentralPubMedGoogle Scholar
  73. 73.
    Sapone A, Bai JC, Ciacci C, Dolinsek J, Green PH, Hadjivassiliou M et al (2012) Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Med 10:13PubMedCentralPubMedGoogle Scholar
  74. 74.
    Volta U, Caio G, Tovoli F, De Giorgio R (2013) Non-celiac gluten sensitivity: questions still to be answered despite increasing awareness. Cell Mol Immunol 10(5):383–392PubMedCentralPubMedGoogle Scholar
  75. 75.
    Wahnschaffe U, Schulzke JD, Zeitz M, Ullrich R (2007) Predictors of clinical response to gluten-free diet in patients diagnosed with diarrhea-predominant irritable bowel syndrome. Clin Gastroenterol Hepatol 5(7):844–850PubMedGoogle Scholar
  76. 76.
    Caio G, Volta U, Tovoli F, De Giorgio R (2014) Effect of gluten free diet on immune response to gliadin in patients with non-celiac gluten sensitivity. BMC Gastroenterol 14:26PubMedCentralPubMedGoogle Scholar
  77. 77.
    Biesiekierski JR, Newnham ED, Irving PM, Barrett JS, Haines M, Doecke JD et al (2011) Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol 106(3):508–514PubMedGoogle Scholar
  78. 78.
    Isasi C, Colmenero I, Casco F, Tejerina E, Fernandez N, Serrano-Vela JI et al (2014) Fibromyalgia and non-celiac gluten sensitivity: a description with remission of fibromyalgia. Rheumatol Int. Apr 12 [Epub ahead of print]Google Scholar
  79. 79.
    Lomer MC, Parkes GC, Sanderson JD (2008) Review article: lactose intolerance in clinical practice–myths and realities. Aliment Pharmacol Ther 27(2):93–103PubMedGoogle Scholar
  80. 80.
    Vesa TH, Marteau P, Korpela R (2000) Lactose intolerance. J Am Coll Nutr 19(Suppl 2):165S–175SPubMedGoogle Scholar
  81. 81.
    Alpers DH (2006) Diet and irritable bowel syndrome. Curr Opin Gastroenterol 22(2):136–169PubMedGoogle Scholar
  82. 82.
    Zhu Y, Zheng X, Cong Y, Chu H, Fried M, Dai N et al (2013) Bloating and distention in irritable bowel syndrome: the role of gas production and visceral sensation after lactose ingestion in a population with lactase deficiency. Am J Gastroenterol 108(9):1516–1525PubMedGoogle Scholar
  83. 83.
    Campbell AK, Matthews SB, Vassel N, Cox CD, Naseem R, Chaichi J et al (2010) Bacterial metabolic ‘toxins’: a new mechanism for lactose and food intolerance, and irritable bowel syndrome. Toxicology 278(3):268–276PubMedGoogle Scholar
  84. 84.
    García-Leiva JM, Ordóñez Carrasco JL, Slim M, Calandre EP (2014) Celiac symptoms in patients with fibromyalgia: a cross-sectional study. Rheumatol Int [under revision]Google Scholar
  85. 85.
    Biesiekierski JR, Muir JG, Gibson PR (2013) Is gluten a cause of gastrointestinal symptoms in people without celiac disease? Curr Allergy Asthma Rep 13(6):631–638PubMedGoogle Scholar
  86. 86.
    Mansueto P, Seidita A, D’Alcamo A, Carroccio A (2014) Non-celiac gluten sensitivity: literature review. J Am Coll Nutr 33(1):39–54PubMedGoogle Scholar
  87. 87.
    Biesiekierski JR, Peters SL, Newnham ED, Rosella O, Muir JG, Gibson PR (2013) No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology 145(2):320–328PubMedGoogle Scholar
  88. 88.
    Staudacher HM, Irving PM, Lomer MC, Whelan K (2014) Mechanisms and efficacy of dietary FODMAP restriction in IBS. Nat Rev Gastroenterol Hepatol 11(4):256–266PubMedGoogle Scholar
  89. 89.
    Grenham S, Clarke G, Cryan JF, Dinan TG (2011) Brain–gut–microbe communication in health and disease. Front Physiol 2:94PubMedCentralPubMedGoogle Scholar
  90. 90.
    Mayer EA (2011) Gut feelings: the emerging biology of gut–brain communication. Nat Rev Neurosci 12(8):453–466PubMedGoogle Scholar
  91. 91.
    Rhee SH, Pothoulakis C, Mayer EA (2009) Principles and clinical implications of the brain–gut–enteric microbiota axis. Nat Rev Gastroenterol Hepatol 6(5):306–314PubMedGoogle Scholar
  92. 92.
    Montiel-Castro AJ, González-Cervantes RM, Bravo-Ruiseco G, Pacheco-López G (2013) The microbiota–gut–brain axis: neurobehavioral correlates, health and sociality. Front Integr Neurosci 7:70PubMedCentralPubMedGoogle Scholar
  93. 93.
    Bures J, Cyrany J, Kohoutova D, Förstl M, Rejchrt S, Kvetina J et al (2010) Small intestinal bacterial overgrowth syndrome. World J Gastroenterol 16(24):2978–2990PubMedCentralPubMedGoogle Scholar
  94. 94.
    Dukowicz AC, Lacy BE, Levine GM (2007) Small intestinal bacterial overgrowth: a comprehensive review. Gastroenterol Hepatol (N Y) 3(2):112–122Google Scholar
  95. 95.
    Singh VV, Toskes PP (2003) Small bowel bacterial overgrowth: presentation, diagnosis, and treatment. Curr Gastroenterol Rep 5(5):365–372PubMedGoogle Scholar
  96. 96.
    Arrieta MC, Bistritz L, Meddings JB (2006) Alterations in intestinal permeability. Gut 55(10):1512–1520PubMedCentralPubMedGoogle Scholar
  97. 97.
    Compare D, Pica L, Rocco A, De Giorgi F, Cuomo R, Sarnelli G et al (2011) Effects of long-term PPI treatment on producing bowel symptoms and SIBO. Eur J Clin Invest 41(4):380–386PubMedGoogle Scholar
  98. 98.
    Addolorato G, Mirijello A, D’Angelo C, Leggio L, Ferrulli A, Abenavoli L et al (2008) State and trait anxiety and depression in patients affected by gastrointestinal diseases: psychometric evaluation of 1641 patients referred to an internal medicine outpatient setting. Int J Clin Pract 62(7):1063–1069PubMedGoogle Scholar
  99. 99.
    Goebel A, Buhner S, Schedel R, Lochs H, Sprotte G (2008) Altered intestinal permeability in patients with primary fibromyalgia and in patients with complex regional pain syndrome. Rheumatology (Oxford) 47(8):1223–1227Google Scholar
  100. 100.
    Riordan SM, McIver CJ, Wakefield D, Duncombe VM, Bolin TD, Thomas MC (1997) Luminal antigliadin antibodies in small intestinal bacterial overgrowth. Am J Gastroenterol 92(8):1335–1338PubMedGoogle Scholar
  101. 101.
    Pimentel M, Chow EJ, Hallegua D, Wallace D, Lin HC (2001) Small intestinal bacterial overgrowth: a possible association with fibromyalgia. J Musculoskelet Pain 9(3):105–113Google Scholar
  102. 102.
    Pimentel M, Wallace D, Hallegua D, Chow E, Kong Y, Park S et al (2004) A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing. Ann Rheum Dis 63(4):450–452PubMedCentralPubMedGoogle Scholar
  103. 103.
    American College of Gastroenterology Task Force on Irritable Bowel Syndrome, Brandt LJ, Chey WD, Foxx-Orenstein AE, Schiller LR, Schoenfeld PS et al (2009) An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol 104(Suppl 1):S1–S35Google Scholar
  104. 104.
    Pimentel M, Lembo A, Chey WD, Zakko S, Ringel Y, Yu J et al (2011) Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med 364(1):22–32PubMedGoogle Scholar
  105. 105.
    Rosania R, Giorgio F, Principi M, Amoruso A, Monno R, Di Leo A et al (2013) Effect of probiotic or prebiotic supplementation on antibiotic therapy in the small intestinal bacterial overgrowth: a comparative evaluation. Curr Clin Pharmacol 8(2):169–172PubMedGoogle Scholar
  106. 106.
    Rao AV, Bested AC, Beaulne TM, Katzman MA, Iorio C, Berardi JM et al (2009) A randomized, double-blind, placebo-controlled pilot study of a probiotic in emotional symptoms of chronic fatigue syndrome. Gut Pathog 1(1):6PubMedCentralPubMedGoogle Scholar
  107. 107.
    Halliez MC, Buret AG (2013) Extra-intestinal and long term consequences of Giardia duodenalis infections. World J Gastroenterol 19(47):8974–8985PubMedCentralPubMedGoogle Scholar
  108. 108.
    Ozsahin M, Gonen I, Ermis F, Oktay M, Besir FH, Kutlucan A et al (2013) The prevalence of fibromyalgia among patients with hepatitis B virus infection. Int J Clin Exp Med 6(9):804–808PubMedCentralPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Mahmoud Slim
    • 1
  • Elena Pita Calandre
    • 1
  • Fernando Rico-Villademoros
    • 1
  1. 1.Instituto de Neurociencias “Federico Olóriz”Universidad de GranadaGranadaSpain

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