Post-Infectious Irritable Bowel Syndrome

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

1. 1.
   Thabane M, Marshall JK. Post-infectious irritable bowel syndrome. World J Gastroenterol. 2009;15:3591–6.CrossRefPubMedPubMedCentralGoogle Scholar
2. 2.
   Dunlop SP, Jenkins D, Spiller RC. Distinctive clinical, psychological, and histological features of post-infective irritable bowel syndrome. Am J Gastroenterol. 2003;98:1578–83.CrossRefPubMedGoogle Scholar
3. 3.
   Chaudhary NA, Truelove SC. The irritable colon syndrome: a study of the clinical features, predisposing causes, and prognosis in 130 cases. Q J Med. 1962;31:307–22.PubMedGoogle Scholar
4. 4.
   •• Marshall JK, Thabane M, Garg AX, Clark WF, Salvadori M, Collins S. Incidence and epidemiology of irritable bowel syndrome after a large waterborne outbreak of bacterial dysentery. Gastroenterology. 2006;131:445–50. This is considered to many as the landmark study of post-infectious IBS. CrossRefPubMedGoogle Scholar
5. 5.
   Borgaonkar MR, Ford DC, Marshall JK, Churchill E, Collins SM. The incidence of irritable bowel syndrome among community subjects with previous acute enteric infection. Dig Dis Sci. 2006;51:1026–32.CrossRefPubMedGoogle Scholar
6. 6.
   Ilnyckyj A, Balachandra B, Elliott L, Choudhri S, Duerksen DR. Post-traveler’s diarrhea irritable bowel syndrome: a prospective study. Am J Gastroenterol. 2003;98:596–9.CrossRefPubMedGoogle Scholar
7. 7.
   Okhuysen PC, Jiang ZD, Carlin L, Forbes C, DuPont HL. Post-diarrhea chronic intestinal symptoms and irritable bowel syndrome in north American travelers to Mexico. Am J Gastroenterol. 2004;99:1774–8.CrossRefPubMedGoogle Scholar
8. 8.
   Rodríguez LAG, Ruigómez A. Increased risk of irritable bowel syndrome after bacterial gastroenteritis: cohort study. BMJ. 1999;318:565–6.CrossRefPubMedPubMedCentralGoogle Scholar
9. 9.
   McKendrick M, Read N. Irritable bowel syndrome—post salmonella infection. J Inf Secur. 1994;29:1–3.Google Scholar
10. 10.
    Mearin F, Badia X, Balboa A, Baró E, Caldwell E, Cucala M, et al. Irritable bowel syndrome prevalence varies enormously depending on the employed diagnostic criteria: comparison of Rome II versus previous criteria in a general population. Scand J Gastroenterol. 2001;36:1155–61.CrossRefPubMedGoogle Scholar
11. 11.
    Stermer E, Lubezky A, Potasman I, Paster E, Lavy A. Is traveler’s diarrhea a significant risk factor for the development of irritable bowel syndrome? A prospective study. Clin Infect Dis. 2006;43:898–0.CrossRefPubMedGoogle Scholar
12. 12.
    Kim HS, Kim MS, Ji SW, Park H. The development of irritable bowel syndrome after Shigella infection: 3 year follow-up study. Korean J Gastroenterol. 2006;47:300–5.PubMedGoogle Scholar
13. 13.
    Moss-Morris R, Spence M. To “lump” or to “split” the functional somatic syndromes: can infectious and emotional risk factors differentiate between the onset of chronic fatigue syndrome and irritable bowel syndrome? Psychosom Med. 2006;68:463–9.CrossRefPubMedGoogle Scholar
14. 14.
    Spence MJ, Moss-Morris R. The cognitive behavioural model of irritable bowel syndrome: a prospective investigation of patients with gastroenteritis. Gut. 2007;56:1066–71.CrossRefPubMedPubMedCentralGoogle Scholar
15. 15.
    Wang L, Fang X, Pan G. Bacillary dysentery as a causative factor of irritable bowel syndrome and its pathogenesis. Gut. 2004;53:1096–101.CrossRefPubMedPubMedCentralGoogle Scholar
16. 16.
    Halvorson HA, Schlett CD, Riddle MS. Postinfectious irritable bowel syndrome—a meta-analysis. Am J Gastroenterol. 2006;101:1894–9.CrossRefPubMedGoogle Scholar
17. 17.
    Thabane M, Kottachchi D, Marshall J. Systematic review and meta-analysis: the incidence and prognosis of post-infectious irritable bowel syndrome. Aliment Pharmacol Ther. 2007;26:535–44.CrossRefPubMedGoogle Scholar
18. 18.
    Thabane M, Simunovic M, Akhtar-Danesh N, Garg AX, Clark WF, Collins SM, et al. An outbreak of acute bacterial gastroenteritis is associated with an increased incidence of irritable bowel syndrome in children. Am J Gastroenterol. 2010;105:933–9.CrossRefPubMedGoogle Scholar
19. 19.
    Mutsch M, Pitzurra R, Hatz C, Steffen R. Post-infectious Sequelae of Travelers' diarrhea: irritable bowel syndrome. J Travel Med. 2014;21:141–3.CrossRefPubMedGoogle Scholar
20. 20.
    Lee YY, Rao SC. Post-infectious irritable bowel syndrome. Biota-Scope 2015;2:10–6.Google Scholar
21. 21.
    •• Lawenko RMA, Lee YY, Nurfadhilah Y, Yaacob N, Mohammad WMZW, Liong MT, et al. The role of gut dysbiosis and probiotics in persistent abdominal pain following a major flood disaster. J Gastroenterol Hepatol. 2016;31:131. This study provides evidence for IBS akin to post-infectious IBS following a major disaster and that probiotic is useful in such a situation. Google Scholar
22. 22.
    Neal K, Hebden J, Spiller R. Prevalence of gastrointestinal symptoms six months after bacterial gastroenteritis and risk factors for development of the irritable bowel syndrome: postal survey of patients. BMJ. 1997;314:779–82.CrossRefPubMedPubMedCentralGoogle Scholar
23. 23.
    Ibarra C, Herrera V. Pérez dAE, Gil L, Madrid A, Valenzuela L, et al. Parasitosis and irritable bowel syndrome. Rev Chil Infectol. 2016;33:268–74.CrossRefGoogle Scholar
24. 24.
    Motomura Y, Khan WI, El-Sharkawy RT, Verma-Gandhu M, Grencis RK, Collins SM. Mechanisms underlying gut dysfunction in a murine model of chronic parasitic infection. Am J Physiol Gastrointest Liver Physiol. 2010;299:G1354–60.CrossRefPubMedGoogle Scholar
25. 25.
    Beatty J, Bhargava A, Buret A. Post-infectious irritable bowel syndrome: mechanistic insights into chronic disturbances following enteric infection. World J Gastroenterol. 2014;20:3976–85.CrossRefPubMedPubMedCentralGoogle Scholar
26. 26.
    Teoh DA, Kamieniecki D, Pang G, Buret AG. Giardia Lamblia rearranges F-actin and α-actinin in human colonic and duodenal monolayers and reduces transepithelial electrical resistance. J Parasitol. 2000;86:800–6.PubMedGoogle Scholar
27. 27.
    Hanevik K, Dizdar V, Langeland N, Hausken T. Development of functional gastrointestinal disorders after Giardia lamblia infection. BMC Gastroenterol. 2009;9:1–5.CrossRefGoogle Scholar
28. 28.
    Buret AG. Pathophysiology of enteric infections with Giardia duodenalis. Parasite. 2008;15:261–5.CrossRefPubMedGoogle Scholar
29. 29.
    Long Y, Wang W, Wang H, Hao L, Qian W, Hou X. Characteristics of intestinal lamina propria dendritic cells in a mouse model of postinfectious irritable bowel syndrome. J Gastroenterol Hepatol. 2012;27:935–44.CrossRefPubMedGoogle Scholar
30. 30.
    Lupp C, Robertson ML, Wickham ME, Sekirov I, Champion OL, Gaynor EC, et al. Host-mediated inflammation disrupts the intestinal microbiota and promotes the overgrowth of Enterobacteriaceae. Cell Host Microbe. 2007;2:119–29.CrossRefPubMedGoogle Scholar
31. 31.
    •• Ghoshal UC, Gwee K-A. Post-infectious IBS, tropical sprue and small intestinal bacterial overgrowth: the missing link. Nat Rev Gastroenterol Hepatol. 2017;14:435–41. This review provides some thought provoking issues in relation to tropical sprue and how it is associated with post-infectious IBS CrossRefPubMedGoogle Scholar
32. 32.
    Malinen E, Rinttilä T, Kajander K, Mättö J, Kassinen A, Krogius L, et al. Analysis of the fecal microbiota of irritable bowel syndrome patients and healthy controls with real-time PCR. Am J Gastroenterol. 2005;100:373–82.CrossRefPubMedGoogle Scholar
33. 33.
    Krogius-Kurikka L, Lyra A, Malinen E, Aarnikunnas J, Tuimala J, Paulin L, et al. Microbial community analysis reveals high level phylogenetic alterations in the overall gastrointestinal microbiota of diarrhoea-predominant irritable bowel syndrome sufferers. BMC Gastroenterol. 2009;9:95.CrossRefPubMedPubMedCentralGoogle Scholar
34. 34.
    •• Jalanka-Tuovinen J, Salojärvi J, Salonen A, Immonen O, Garsed K, Kelly FM, et al. Faecal microbiota composition and host–microbe cross-talk following gastroenteritis and in postinfectious irritable bowel syndrome. Gut. 2014;63:1737–45. The faecal microbiota of patients with PI-IBS differ from that of healthy controls and resemble patients with IBS-D, suggesting a common pathophysiology. CrossRefPubMedGoogle Scholar
35. 35.
    Levy RL, Jones KR, Whitehead WE, Feld SI, Talley NJ, Corey LA. Irritable bowel syndrome in twins: heredity and social learning both contribute to etiology. Gastroenterology. 2001;121:799–804.CrossRefPubMedGoogle Scholar
36. 36.
    Spiller RC. Postinfectious irritable bowel syndrome. Gastroenterology. 2003;124:1662–71.CrossRefPubMedGoogle Scholar
37. 37.
    Van Der Veek PP, Van Den Berg M, De Kroon YE, Verspaget HW, Masclee AA. Role of tumor necrosis factor-α and interleukin-10 gene polymorphisms in irritable bowel syndrome. Am J Gastroenterol. 2005;100:2510–6.CrossRefPubMedGoogle Scholar
38. 38.
    Villani AC, Lemire M, Thabane M, Belisle A, Geneau G, Garg AX, et al. Genetic risk factors for post-infectious irritable bowel syndrome following a waterborne outbreak of gastroenteritis. Gastroenterology. 2010;138:1502–13.CrossRefPubMedGoogle Scholar
39. 39.
    Spiller RC, Jenkins D, Thornley JM, Hebden J, Wright T, Skinner M, et al. Increased rectal mucosal enteroendocrine cells, T lymphocytes, and increased gut permeability following acuteCampylobacter enteritis and in post-dysenteric irritable bowel syndrome. Gut. 2000;47:804–11.CrossRefPubMedPubMedCentralGoogle Scholar
40. 40.
    Keating C, Beyak M, Foley S, Singh G, Marsden C, Spiller R, et al. Afferent hypersensitivity in a mouse model of post-inflammatory gut dysfunction: role of altered serotonin metabolism. J Physiol. 2008;586:4517–30.CrossRefPubMedPubMedCentralGoogle Scholar
41. 41.
    Barbara G, Wang B, Stanghellini V, De Giorgio R, Cremon C, Di Nardo G, et al. Mast cell-dependent excitation of visceral-nociceptive sensory neurons in irritable bowel syndrome. Gastroenterology. 2007;132:26–37.CrossRefPubMedGoogle Scholar
42. 42.
    Mearin F, Perelló A, Balboa A, Perona M, Sans M, Salas A, et al. Pathogenic mechanisms of postinfectious functional gastrointestinal disorders: results 3 years after gastroenteritis. Scand J Gastroenterol. 2009;44:1173–85.CrossRefPubMedGoogle Scholar
43. 43.
    Barbara G, Stanghellini V, De Giorgio R, Cremon C, Cottrell GS, Santini D, et al. Activated mast cells in proximity to colonic nerves correlate with abdominal pain in irritable bowel syndrome. Gastroenterology. 2004;126:693–702.CrossRefPubMedGoogle Scholar
44. 44.
    Park JH, Rhee PL, Kim HS, Lee JH, Kim YH, Kim JJ, et al. Mucosal mast cell counts correlate with visceral hypersensitivity in patients with diarrhea predominant irritable bowel syndrome. J Gastroenterol Hepatol. 2006;21:71–8.CrossRefPubMedGoogle Scholar
45. 45.
    Sundin J, Rangel I, Kumawat AK, Hultgren-Hörnquist E, Brummer RJ. Aberrant mucosal lymphocyte number and subsets in the colon of post-infectious irritable bowel syndrome patients. Scand J Gastroenterol. 2014;49:1068–75.CrossRefPubMedGoogle Scholar
46. 46.
    Sundin J, Rangel I, Fuentes S, Heikamp-de Jong I, Hultgren-Hörnquist E, Vos W, et al. Altered faecal and mucosal microbial composition in post-infectious irritable bowel syndrome patients correlates with mucosal lymphocyte phenotypes and psychological distress. Aliment Pharmacol Ther. 2015;41:342–51.CrossRefPubMedGoogle Scholar
47. 47.
    Gwee K, Collins S, Read N, Rajnakova A, Deng Y, Graham J, et al. Increased rectal mucosal expression of interleukin 1β in recently acquired post-infectious irritable bowel syndrome. Gut. 2003;52:523–6.CrossRefPubMedPubMedCentralGoogle Scholar
48. 48.
    Ghoshal UC, Shukla R, Ghoshal U, Gwee K-A, Ng SC, Quigley EM. The gut microbiota and irritable bowel syndrome: friend or foe? Int J Inflam. 2012;2012:13.CrossRefGoogle Scholar
49. 49.
    Lee YA, Nam YH, Min A, et al. Entamoeba histolytica-secreted cysteine proteases induce IL-8 production in human mast cells via a PAR2-independent mechanism. Parasite. 2014;21:1.CrossRefPubMedPubMedCentralGoogle Scholar
50. 50.
    Clarke G, McKernan DP, Gaszner G, Quigley EM, Cryan JF, Dinan TG. Increased Kynurenine production following toll-like receptor (TLR) activation: a novel role for Tlr8 in irritable bowel syndrome (IBS). Gastroenterology. 2011;140(5):S-111.Google Scholar
51. 51.
    Brint EK, MacSharry J, Fanning A, Shanahan F, Quigley EM. Differential expression of toll-like receptors in patients with irritable bowel syndrome. Am J Gastroenterol. 2011;106(2):329–36.CrossRefPubMedGoogle Scholar
52. 52.
    Belmonte L, Youmba SB, Bertiaux-Vandaele N, Antonietti M, Lecleire S, Zalar A, et al. Role of toll like receptors in irritable bowel syndrome: differential mucosal immune activation according to the disease subtype. PLoS One. 2012;7:e42777.CrossRefPubMedPubMedCentralGoogle Scholar
53. 53.
    Hansson GC. Role of mucus layers in gut infection and inflammation. Curr Opin Microbiol. 2012;15:57–62.CrossRefPubMedGoogle Scholar
54. 54.
    Faure M, Moënnoz D, Montigon F, Mettraux C, Breuillé D, Ballèvre O. Dietary threonine restriction specifically reduces intestinal mucin synthesis in rats. J Nutr. 2005;135:486–91.PubMedGoogle Scholar
55. 55.
    Kashyap PC, Marcobal A, Ursell LK, Smits SA, Sonnenburg ED, Costello EK, et al. Genetically dictated change in host mucus carbohydrate landscape exerts a diet-dependent effect on the gut microbiota. Proc Natl Acad Sci U S A. 2013;110:17059–64.CrossRefPubMedPubMedCentralGoogle Scholar
56. 56.
    Simpson J, Sundler F, Humes D, Jenkins D, Wakelin D, Scholefield J, et al. Prolonged elevation of galanin and tachykinin expression in mucosal and myenteric enteric nerves in trinitrobenzene sulphonic acid colitis. Neurogastroenterol Motil. 2008;20:392–406.CrossRefPubMedGoogle Scholar
57. 57.
    Akbar A, Yiangou Y, Facer P, Walters JR, Anand P, Ghosh S. Increased capsaicin receptor TRPV1-expressing sensory fibres in irritable bowel syndrome and their correlation with abdominal pain. Gut. 2008;57:923–9.CrossRefPubMedPubMedCentralGoogle Scholar
58. 58.
    Törnblom H, Lindberg G, Nyberg B, Veress B. Full-thickness biopsy of the jejunum reveals inflammation and enteric neuropathy in irritable bowel syndrome. Gastroenterology. 2002;123:1972–9.CrossRefPubMedGoogle Scholar
59. 59.
    Gwee KA, Lu CL, Ghoshal UC. Epidemiology of irritable bowel syndrome in Asia: something old, something new, something borrowed. J Gastroenterol Hepatol. 2009;24:1601–7.CrossRefPubMedGoogle Scholar
60. 60.
    Wouters MM, Van Wanrooy S, Nguyen A, Dooley J, Aguilera-Lizarraga J, Van Brabant W, et al. Psychological comorbidity increases the risk for postinfectious IBS partly by enhanced susceptibility to develop infectious gastroenteritis. Gut. 2016;65:1279–88.CrossRefPubMedGoogle Scholar
61. 61.
    Kiank C, Taché Y, Larauche M. Stress-related modulation of inflammation in experimental models of bowel disease and post-infectious irritable bowel syndrome: role of corticotropin-releasing factor receptors. Brain Behav Immun. 2010;24:41–8.CrossRefPubMedGoogle Scholar
62. 62.
    Clarke G, Cryan J, Dinan T, Quigley EM. Probiotics for the treatment of irritable bowel syndrome–focus on lactic acid bacteria. Aliment Pharmacol Ther. 2012;35:403–13.CrossRefPubMedGoogle Scholar
63. 63.
    Huang JS, Bousvaros A, Lee JW, Diaz A, Davidson EJ. Efficacy of probiotic use in acute diarrhea in children: a meta-analysis. Dig Dis Sci. 2002;47:2625–34.CrossRefPubMedGoogle Scholar
64. 64.
    O’Mahony L, McCarthy J, Kelly P, Hurley G, Luo F, Chen K, et al. Lactobacillus and bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles. Gastroenterology. 2005;128:541–51.CrossRefPubMedGoogle Scholar
65. 65.
    Cuomo R, Savarese MF, Gargano R. Almost all irritable bowel syndromes are post-infectious and respond to probiotics: consensus issues. Dig Dis. 2007;25:241–4.CrossRefPubMedGoogle Scholar
66. 66.
    Verdu EF, Bercik P, Verma-Gandhu M, Huang X-X, Blennerhassett P, Jackson W, et al. Specific probiotic therapy attenuates antibiotic induced visceral hypersensitivity in mice. Gut. 2006;55:182–90.CrossRefPubMedPubMedCentralGoogle Scholar
67. 67.
    Parry SD, Barton JR, Welfare MR. Factors associated with the development of post-infectious functional gastrointestinal diseases: does smoking play a role? Eur J Gastroenterol Hepatol. 2005;17:1071–5.CrossRefPubMedGoogle Scholar
68. 68.
    Lee YY, Waid A, Tan HJ, Chua AS, Whitehead WE. Rome III survey of irritable bowel syndrome among ethnic Malays. World J Gastroenterol. 2012;18:6475–80.CrossRefPubMedPubMedCentralGoogle Scholar
69. 69.
    McCarroll MG, Riddle MS, Gutierrez RL, Porter CK. Infectious gastroenteritis as a risk factor for tropical Sprue and Malabsorption: a case–control study. Dig Dis Sci. 2015;60:3379–85.CrossRefPubMedGoogle Scholar
70. 70.
    David L-E, Surdea-Blaga T, Dumitrascu D-L. Semiquantitative fecal calprotectin test in postinfectious and non-postinfectious irritable bowel syndrome: cross-sectional study. Sao Paulo Med J. 2015;133:343–9.CrossRefPubMedGoogle Scholar
71. 71.
    Pimentel M, Morales W, Rezaie A, Marsh E, Lembo A, Mirocha J, et al. Development and validation of a biomarker for diarrhea-predominant irritable bowel syndrome in human subjects. PLoS One. 2015;10:e0126438.CrossRefPubMedPubMedCentralGoogle Scholar
72. 72.
    •• Marshall J, Thabane M, Garg A, Clark W, Moayyedi P, Collins S. Walkerton health study investigators. Eight year prognosis of postinfectious irritable bowel syndrome following waterborne bacterial dysentery. Gut. 2010;59:605–11. This study provides data on prognosis of post-infectious IBS for eight years. CrossRefPubMedGoogle Scholar
73. 73.
    • Abdul Rani R, Ali R, Affendi R, Lee YY. Irritable bowel syndrome and inflammatory bowel disease overlap syndrome: pieces of the puzzle are falling into place. Intest Res. 2016;14:297–304. Both IBD and IBS have significant overlap in terms of symptoms, pathophysiology, and treatment, suggesting the possibility of IBS and IBD being a single disease entity albeit at opposite ends of the spectrum. CrossRefPubMedPubMedCentralGoogle Scholar
74. 74.
    Hilmi I, Hartono JL, Pailoor J, Mahadeva S, Goh K-L. Low prevalence of ‘classical’microscopic colitis but evidence of microscopic inflammation in Asian irritable bowel syndrome patients with diarrhoea. BMC Gastroenterol. 2013;13:80.CrossRefPubMedPubMedCentralGoogle Scholar
75. 75.
    Porter CK, Cash BD, Pimentel M, Akinseye A, Riddle MS. Risk of inflammatory bowel disease following a diagnosis of irritable bowel syndrome. BMC Gastroenterol. 2012;12:55.CrossRefPubMedPubMedCentralGoogle Scholar
76. 76.
    Efskind P, Bernklev T, Vatn M. A double-blind placebo-controlled trial with loperamide in irritable bowel syndrome. Scand J Gastroenterol. 1996;31(5):463–8.CrossRefPubMedGoogle Scholar
77. 77.
    Drossman DA, Toner BB, Whitehead WE, Diamant NE, Dalton CB, Duncan S, et al. Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Gastroenterology. 2003;125:19–31. Epub 2003/07/10 CrossRefPubMedGoogle Scholar
78. 78.
    Corinaldesi R, Stanghellini V, Cremon C, Gargano L, Cogliandro R, De Giorgio R, et al. Effect of mesalazine on mucosal immune biomarkers in irritable bowel syndrome: a randomized controlled proof-of-concept study. Aliment Pharmacol Ther. 2009;30:245–52.CrossRefPubMedGoogle Scholar
79. 79.
    Andrews C, Griffiths T, Kaufman J, Vergnolle N, Surette M, Rioux K. Mesalazine (5- aminosalicylic acid) alters faecal bacterial profiles, but not mucosal proteolytic activity in diarrhoea- predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2011;34(3):374–83.CrossRefPubMedGoogle Scholar
80. 80.
    Lam C, Tan W, Leighton M, Hastings M, Lingaya M, Falcone Y, et al. A mechanistic multicentre, parallel group, randomised placebo-controlled trial of mesalazine for the treatment of IBS with diarrhea (IBS-D). Gut. 2016;65:91–9.CrossRefPubMedGoogle Scholar
81. 81.
    Erdogan A, Rao SS, Gulley D, Jacobs C, Lee YY, Badger C. Small intestinal bacterial overgrowth: duodenal aspiration vs glucose breath test. Neurogastroenterol Motil. 2015;27:481–9.CrossRefPubMedGoogle Scholar
82. 82.
    Sharara AI, Aoun E, Abdul-Baki H, Mounzer R, Sidani S, Elhajj. A randomized double-blind placebo-controlled trial of rifaximin in patients with abdominal bloating and flatulence. I. A C. Am J Gastroenterol. 2006; 101:326.Google Scholar
83. 83.
    •• Pimentel M, Lembo A, Chey WD, Zakko S, Ringel Y, Yu J, et al. Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med. 2011;364:22–32. In this landmark trial, rifaximin has been shown to be effective in IBS-D and possibility post-infectious IBS too. CrossRefPubMedGoogle Scholar
84. 84.
    Lembo A, Pimentel M, Rao SS, Schoenfeld P, Cash B, Weinstock LB, et al. Repeat treatment with Rifaximin is safe and effective in patients with diarrhea-predominant irritable bowel syndrome. Gastroenterology. 2016;151:1113–21.CrossRefPubMedGoogle Scholar
85. 85.
    Krause R, Ameen V, Gordon SH, West M, Heath AT, Perschy T, et al. A randomized, double-blind, placebo-controlled study to assess efficacy and safety of 0.5 Mg and 1 mg alosetron in women with severe diarrhea-predominant IBS. Am J Gastroenterol. 2007;102:1709.CrossRefPubMedGoogle Scholar
86. 86.
    Fukudo S, Ida M, Akiho H, et al. Effect of ramosetron on stool consistency in male patients with irritable bowel syndrome with diarrhea. Clin Gastroenterol Hepatol. 2014;12:953–9.CrossRefPubMedGoogle Scholar
87. 87.
    Fukudo S, Kinoshita Y, Okumura T, Ida M, Akiho H, Nakashima Y, et al. Ramosetron reduces symptoms of irritable bowel syndrome with diarrhea and improves quality of life in women. Gastroenterology. 2016;150:358–66.e8.CrossRefPubMedGoogle Scholar
88. 88.
    Garsed K, Chernova J, Hastings M, Lam C, Marciani L, Singh G, et al. A randomised atrial of ondansetron for the treatment of irritable bowel syndrome with diarrhoea. Gut. 2014;63:1617–25.CrossRefPubMedGoogle Scholar
89. 89.
    • Zheng Y, Yu T, Tang Y, Xiong W, Shen X, Jiang L, et al. Efficacy and safety of 5-hydroxytryptamine 3 receptor antagonists in irritable bowel syndrome: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2017;12:e0172846. Ramosetron, cilansetron, ondansetron, and alosetron are effective for treating non-constipated IBS and IBS-D. This systematic review found only rare serious adverse events associated with these drugs. CrossRefPubMedPubMedCentralGoogle Scholar
90. 90.
    Abbas Z, Yakoob J, Jafri W, Ahmad Z, Azam Z, Usman MW, et al. Cytokine and clinical response to saccharomyces boulardii therapy in diarrhea-dominant irritable bowel syndrome: a randomized trial. Eur J Gastroenterol Hepatol. 2014;26:630–9.CrossRefPubMedGoogle Scholar
91. 91.
    Symons P, Jones M, Kellow J. Symptom provocation in irritable bowel syndrome effects of differing doses of fructose-sorbitol. Scand J Gastroenterol. 1992;27:940–4.CrossRefPubMedGoogle Scholar
92. 92.
    Goldstein R, Braverman D, Stankiewicz H. Carbohydrate malabsorption and the effect of dietary restriction on symptoms of irritable bowel syndrome and functional bowel complaints. Isr Med Assoc J. 2000;2:583–7.PubMedGoogle Scholar
93. 93.
    Barrett JS, Gibson PR. Fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and nonallergic food intolerance: FODMAPs or food chemicals? Therap Adv Gastroenterol. 2012;5:261–8.CrossRefPubMedPubMedCentralGoogle Scholar
94. 94.
    Marsh A, Eslick EM, Eslick GD. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. Eur J Nutr. 2016;55:897–906.CrossRefPubMedGoogle Scholar
95. 95.
    Ruepert L, Quartero AO, de Wit NJ, van der Heijden GJ, Rubin G, Muris JWM. Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome. Cochrane Database of Syst Rev. 2011;8:CD003460.Google Scholar
96. 96.
    Khanna R, MacDonald JK, Levesque BG. Peppermint oil for the treatment of irritable bowel syndrome: a systematic review and meta-analysis. J Clin Gastroenterol. 2014;48:505–12.PubMedGoogle Scholar
97. 97.
    Dove LS, Lembo A, Randall CW, Fogel R, Andrae D, Davenport JM, et al. Eluxadoline benefits patients with irritable bowel syndrome with diarrhea in a phase 2 study. Gastroenterology. 2013;145:329–38.CrossRefPubMedGoogle Scholar
98. 98.
    Ford AC, Moayyedi P, Lacy BE, Lembo AJ, Saito YA, Schiller LR, et al. American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. Am J Gastroenterol. 2014;109:S2–26.CrossRefPubMedGoogle Scholar