Irritable Bowel Syndrome and Microbial Pathogenesis

  • I. W. Fong
Part of the Emerging Infectious Diseases of the 21st Century book series (EIDC, volume 1)


Irritable bowel syndrome [IBS] is a common disturbance of the gastrointestinal tract of unknown cause, which is more prevalent in greater developed and affluent societies than poorer, developing regions of the world. Yet underdeveloped or developing countries have much greater incidence of infectious diarrheas, which is a strong risk factor for IBS in westernized societies. The prevalence of IBS in different countries, epidemiological association with sporadic or local outbreak of gastroenteritis, and traveler’s diarrhea are reviewed. Other risk factors and various hypotheses on the pathogenesis of IBS are discussed. Data on the emerging role of disturbances in the gut microbiota and microbiome from clinical studies and animal experimentation are analyzed and critiqued. Moreover, studies on the therapeutic benefit of new antimicrobials and probiotics are reviewed, and directions for future research and clinical trials to establish causality are suggested.


Irritable Bowel Syndrome Chronic Fatigue Syndrome Intestinal Microbiota Irritable Bowel Syndrome Patient Fatty Acid Amide Hydrolase 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Talley NJ. Irritable bowel syndrome. In: Feldman M, Friedman LS, Brandt LI, editors. Sleisenger & Fortan’s gastrointestinal and liver diseases. 9th ed. Philadelphia, PA: Sanders Elsevier; 2010. p. 2091–104.Google Scholar
  2. 2.
    Brandt LI, Chey WD, Foxx-Orenstein AE, et al. Systematic review of the management of irritable bowel syndrome in North America. American College Of Gastroenterology Task force on IBS. Am J Gastroenterol. 2009;104 Suppl 1:S1–35.PubMedGoogle Scholar
  3. 3.
    Dupont HL, Galler G, Garcia-Torres F, et al. Travel and travelers’ diarrhea in patients with irritable bowel syndrome. Am J Trop Med Hyg. 2010;82:301–5.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Spiller R, Garsed K. Post-infectious irritable bowel syndrome. Gastroenterology. 2009;136:1979–88.PubMedGoogle Scholar
  5. 5.
    Owyang C. Irritable bowel syndrome. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jamieson JL, Loscalzo J, editors. Harrison is principles of internal medicine. 18th ed. New York, NY: McGraw Hill Medical; 2011. p. 2496–501.Google Scholar
  6. 6.
    Drossman D, Camilleri M, Mayer E, Whitehead W. AGA technical review on Irritable Bowel Syndrome. Gastroenterology. 2002;123:2108–31.PubMedGoogle Scholar
  7. 7.
    Wheeler JG, Sethi D, Cowden M, et al. Study of infectious intestinal disease in England: rates in the community, presenting to general practice, and reported to national surveillance. The Infectious Intestinal Disease Study Executive. Br Med J. 1999;318:1046–50.Google Scholar
  8. 8.
    Stewart GT. Post-dysenteric colitis. Br Med J. 1950;1:405–9.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Chaudhary NA, Truclove SC. The irritable bowel syndrome: a study of clinical features, predisposing causes and prognosis in 130 cases. Q J Med. 1962;31:307–22.PubMedGoogle Scholar
  10. 10.
    Rodriquez LA, Ruigomez A. Increased risk of irritable bowel syndrome after bacterial gastroenteritis: cohort study. Br Med J. 1997;318:565–6.Google Scholar
  11. 11.
    Ilnyckyi A, Balachandra B, Elliot L, Choudri S, Duerksen DR. Post-traveler’s diarrhea irritable bowel syndrome: a prospective study. Am J Gastroenterol. 2003;98:596–9.Google Scholar
  12. 12.
    Parry SD, Stanfield R, Jelley D, et al. Does bacterial gastroenteritis predispose people to functional gastrointestinal disorders? A prospective, community-based, case–control study. Am J Gastroenterol. 2003;98:1970–5.PubMedGoogle Scholar
  13. 13.
    Wang LH, Fang XC, Pan GZ. Bacillary dysentery as a causative factor of irritable bowel syndrome and its pathogenesis. Gut. 2004;53:1096–101.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Ji S, Park H, Lee D, Song YK, Choi JP, Lee SI. Post-infectious irritable bowel syndrome in patients with Shigella infection. J Gastroenterol Hepatol. 2005;20:381–6.PubMedGoogle Scholar
  15. 15.
    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
  16. 16.
    Mearin F, Perez-Oliveras M, Perello A, Vinret J, Ibanez A, Coder KJ, Perona M. Dyspepsia and irritable bowel syndrome after salmonella outbreak: 1 year follow-up cohort study. Gastroenterology. 2005;129:98–104.PubMedGoogle Scholar
  17. 17.
    Marshall JK, Thabane M, Garg AX, Clark WK, Salvadori M, Collins SM. Incidence and epidemiology of irritable bowel syndrome after a large waterborne outbreak of bacterial dysentery. Gastroenterology. 2006;131:445–50.PubMedGoogle Scholar
  18. 18.
    Marshall JK, Thabane M, Garg X, Clark WF, Moayyedi P, Collins SM, Walkerton Health Study Investigators. Eight year prognosis of post-infectious irritable bowel syndrome following waterborne bacterial dysentery. Gut. 2010;59:605–11.PubMedGoogle Scholar
  19. 19.
    Thabane M, Simunovic M, Akhtar-Danesh N, et al. An outbreak of acute gastroenteritis is associated with increased incidence of irritable bowel syndrome in children. Am J Gastroenterol. 2010;105:933–7.PubMedGoogle Scholar
  20. 20.
    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.PubMedGoogle Scholar
  21. 21.
    McKeown ES, Parry SD, Stanfield R, Barton JR, Welfare MR. Post-Infectious irritable bowel syndrome may occur after non-gastrointestinal and intestinal infection. Neurogastroenterol Motil. 2006;18:839–43.PubMedGoogle Scholar
  22. 22.
    Stermer E, Lubezky A, Potasman I, Paster E, Levy A. Is travelers’ diarrhea a significant risk factor for the development of irritable bowel syndrome? A prospective study. Clin Infect Dis. 2006;43:898–901.PubMedGoogle Scholar
  23. 23.
    Marshall JK, Thabane M, Borgaonkar MR, James C. Post-Infectious irritable bowel syndrome after a food–borne outbreak of acute gastroenteritis attributed to a viral pathogen. Clin Gastroenterol Hepatol. 2007;5:457–60.PubMedGoogle Scholar
  24. 24.
    Soyturk M, Akpinar H, Gurler O, et al. Irritable bowel syndrome in persons who acquired trichinellosis. Am J Gastroenterol. 2007;102:1064–9.PubMedGoogle Scholar
  25. 25.
    Jung IS, Kim HS, Park H, Lee SJ. The clinical course of post-infectious irritable bowel syndrome. A 5-year follow-up study. J Clin Gastroenterol. 2009;43:534–40.26.PubMedGoogle Scholar
  26. 26.
    Wensaas KA, Langeland N, Hanervik K, Morch K, Eide GE, Rorveit G. Irritable bowel syndrome and chronic fatigue 3 years after acute giardiasis: historic controlled study. Gut. 2012;61:214–9.PubMedGoogle Scholar
  27. 27.
    Mearin F, Badia X, Balboa A, et al. Irritable bowel syndrome prevalence varies enormously depending on the employed diagnostic criteria: comparison of Rome 11 versus previous diagnostic criteria in the general population. Scand J Gastroenterol. 2001;36:1155–61.PubMedGoogle Scholar
  28. 28.
    Tornblom H, Holmvall P, Svenungsson B, Linberg G. Gastrointestinal symptoms after infectious diarrhea: a 5-year follow-up in the Swedish cohort of adults. Clin Gastroenterol Hepatol. 2007;5:461–4.PubMedGoogle Scholar
  29. 29.
    Schwitte-Kiuntke J, Enck P, Zendler C, et al. Post-infectious irritable bowel syndrome: follow-up of a cohort on confirmed cases of bacterial infection with Salmonella or Campylobacter. Neuro Gastroenterol Motil. 2011;23:e479–88.Google Scholar
  30. 30.
    Haagsma JA, Siersema PD, Dewit NJ, Havelaar AH. Disease burden of post-infectious irritable bowel syndrome in the Netherlands. Epidemiol Infect. 2010;138:1650–6.PubMedGoogle Scholar
  31. 31.
    Ghoshal UG, Abraham P, Bhatt C, et al. Epidemiological and clinical profile of irritable bowel syndrome in India: report of the Indian Society of Gastroenterology Task force. Indian J Gastroenterol. 2008;27:22–8.PubMedGoogle Scholar
  32. 32.
    Danwat D, Tankeyoon M, Sriratanaban A. Prevalence of irritable bowel syndrome in non-Western population. Br Med J. 1988;296:1710.Google Scholar
  33. 33.
    Masud MA, Hasan M, Khan AK. Irritable bowel syndrome in a rural community in Bangladesh: prevalence, symptoms pattern, and healthcare seeking behavior. Am J Gastroenterol. 2001;96:1547–52.PubMedGoogle Scholar
  34. 34.
    Liu J, Hou X. A review of the irritable bowel syndrome on epidemiology, pathogenesis and pathophysiology in China. J Gastroenterol Hepatol. 2011;2 Suppl 3:88–93.Google Scholar
  35. 35.
    Hussain N, Chaudhry IB, Jafri F, Maz SK, Tomenson B, Creed F. A population-based study of irritable bowel syndrome in a non-Western population. Neurogastroenterol Motil. 2008;20:1022–9.Google Scholar
  36. 36.
    Hungin APS, Whorwell PJ, Tack J, Mearin F. The prevalence, patterns, and impact of irritable bowel syndrome: an international survey of 40,000 subjects. Aliment Pharmacol Ther. 2003;17:643–50.PubMedGoogle Scholar
  37. 37.
    Gwee KA, Lu C-L, Ghoshal UC. Epidemiology of irritable bowel syndrome in Asia: something old, something new, something borrowed. Gastroenterol Hepatol. 2009;24:1601–7.Google Scholar
  38. 38.
    Halvorson HA, Schlett CD, Riddle MS. Post-infectious irritable bowel syndrome – a meta-analysis. Am J Gastroenterol. 2006;101:1894–9.PubMedGoogle Scholar
  39. 39.
    Thabane M, Kottachchi DT, Marshall JK. Systematic review and meta-analysis: the incidence and prognosis of post-infectious irritable bowel syndrome. Aliment Pharmacol Ther. 2007;26:535–44.PubMedGoogle Scholar
  40. 40.
    Piche T, Vanbierliet G, Pipau FG, Dainese R, Hebutene X, Rampal P, Collins SM. Low risk of irritable bowel syndrome after Clostridium difficile infection. Can J Gastroenterol. 2007;21:727–31.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Hanevik K, Dizder V, Langeland N, Hausen T. Development of functional disorders after Giardia lamblia infection. BMC Gastroenterol. 2009;9:27.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Grazioli M, Matera G, Laratta C, et al. Giardia lamblia infection in patients with irritable bowel syndrome and dyspepsia: a prospective study. World J Gastroenterol. 2006;12:1941–4.PubMedPubMedCentralGoogle Scholar
  43. 43.
    D’Anchino M, Orlando D, Defeudis L. Giardia lamblia infections become clinically evident by eliciting symptoms of irritable bowel syndrome. J Infect. 2002;45:169–72.PubMedGoogle Scholar
  44. 44.
    Sinha P, Ghoshal UC, Choudhuri G, Naik S, Aggagari A, Naik SR. Does Entamoeba histolytica cause irritable bowel syndrome? Indian J Gastroenterol. 1997;16:130–3.PubMedGoogle Scholar
  45. 45.
    Anand AC, Reddy PS, Saiprasad GS, Kher SK. Does non-dysenteric intestinal amoebiasis exist? Lancet. 1997;349:89–92.PubMedGoogle Scholar
  46. 46.
    Ghoshal UC, Rajan P. Post-infectious irritable bowel syndrome: the past, present and future. J Gastroenterol Hepatol. 2011;26 Suppl 3:94–101.PubMedGoogle Scholar
  47. 47.
    Whitehead WE, Pallson O, Jones KR. Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications? Gastroenterology. 2002;122:1140–56.PubMedGoogle Scholar
  48. 48.
    Thabane M, Kottahichi DT, Marshall JK. Systematic review and meta-analysis: the incidence and prognosis of post-infectious irritable bowel syndrome. Aliment Pharmacol Ther. 2007;26:534–44.Google Scholar
  49. 49.
    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.PubMedGoogle Scholar
  50. 50.
    Saito YA. Genes and irritable bowel syndrome: is there a link? Curr Gastroenterol Rep. 2008;10:355–62.PubMedPubMedCentralGoogle Scholar
  51. 51.
    Villani AC, Lemire M, Thabane M, et al. Genetic risk factors for post-infectious irritable bowel syndrome following a waterborne outbreak of gastroenteritis. Gastroenterology. 2010;138:1502–13.PubMedGoogle Scholar
  52. 52.
    Gonsalkorale WM, Perrey C, Pravica V, et al. Interleukin-10 genotypes in irritable bowel syndrome: evidence of an inflammatory component? Gut. 2003;52:91–3.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Van der Veek PP, van den Berg M, de Kroon YE, et al. Role of tumor necrosis factor-α, and interleukin-10 gene polymorphisms in irritable bowel syndrome. Am J Gastroenterol. 2005;100:2510–6.PubMedGoogle Scholar
  54. 54.
    Strege RR, Saito-Loftus YA, Tester DJ, et al. G298S mutation in Nav 1.5 in a patient with irritable bowel syndrome reduces sodium current density and mechanosensitivity [abstract]. Gastroenterology. 2007;132(4 Suppl 2):A148.Google Scholar
  55. 55.
    Camilleri M, Carlson P, McKinzie S, et al. Genetic variation in endocanniboid metabolism, gastrointestinal motility, and sensation. Am J Physiol Gastrointest Liver Physiol. 2008;294:G13–9.PubMedGoogle Scholar
  56. 56.
    Van Kerkhoven LA, Laheij RJ, Jansen JB. Meta-analysis: a functional polymorphism in the gene encoding for activity of the serotonin transporter protein is not associated with the irritable bowel syndrome. Aliment Pharmacol Ther. 2007;26:979–86.PubMedGoogle Scholar
  57. 57.
    Park JM, Choi MG, Cho YK, Lee IS, Kim SW, Chung IS. Cannabinoid receptor 1 gene polymorphism and irritable bowel syndrome in the Korean population: hypothesis-generating study. J Clin Gastroenterol. 2011;45:45–9.PubMedGoogle Scholar
  58. 58.
    Mc Keman DP, Gaszner G, Quigley EM, Cryan JF, Dinan TG. Altered peripheral toll-like receptor responses in the irritable bowel syndrome. Aliment Pharmacol Ther. 2011;33:1045–52.Google Scholar
  59. 59.
    Troeger H, LoddenKemper C, Schneider T, et al. Structural and functional changes of the duodenum in human norovirus infection. Gut. 2009;58:1070–7.PubMedGoogle Scholar
  60. 60.
    Salim AF, Phillips AD, Walker-Smith JA, et al. Sequential changes in small intestinal structure and function during rotavirus infection in neonatal rats. Gut. 1995;36:231–8.PubMedPubMedCentralGoogle Scholar
  61. 61.
    Hanevik K, Hausken T, Marken MH, et al. Persistent symptoms and duodenal inflammation related to Giardia duodenalis infection. J Infect. 2007;55:524–30.PubMedGoogle Scholar
  62. 62.
    Ina K, Kusugami K, Ohta M. Bacterial hemorrhagic enterocolitis. J Gastroenterol. 2003;38:111–20.PubMedGoogle Scholar
  63. 63.
    Ford AC, Talley NJ. Mucosal inflammation as a potential etiological factor in irritable bowel syndrome: systematic review. J Gastroenterol. 2011;46:421–31.PubMedGoogle Scholar
  64. 64.
    Scully P, Mc Kernan DP, Keohane J, et al. Plasma cytokine profiles in females with irritable bowel syndrome and extraintestinal comorbidity. Am J Gastroenterol. 2010;105:2235–43.PubMedGoogle Scholar
  65. 65.
    Liebregts T, Adam B, Bredack C, et al. Immune activation in patients with irritable bowel syndrome. Gastroenterology. 2008;134:577–94.Google Scholar
  66. 66.
    Gwee KA, Collins SM, Read NW, et al. Increased rectal mucosa expression of interleukin-1 beta in recently acquired post-infection irritable bowel syndrome. Gut. 2003;52:523–6.PubMedPubMedCentralGoogle Scholar
  67. 67.
    Ohman L, Simren M. Pathogenesis of IBS: role of inflammation, immunity and neuroimmune interactions. Nat Rev Gastroenterol Hepatol. 2010;7:163–73.PubMedGoogle Scholar
  68. 68.
    Kindt S, Van Oudenhove L, Broekaert D, et al. Immune dysfunction in patients with functional gastrointestinal disorders. Neurogastroenterol Motil. 2009;21:389–98.PubMedGoogle Scholar
  69. 69.
    O’Mahony L, Mc Carthy J, Kelly P, et al. Lactobacillus and Bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles. Gastroenterology. 2005;128:541–51.PubMedGoogle Scholar
  70. 70.
    Spiller R, Jenkins D, Thornley JP, Hebden JM, Wright T, Skinner M, Neal UR. Increased rectal mucosal enteroendocrine cells, T-lymphocytes and increase gut permeability following acute Campylobacter enteritis and in post-dysenteric irritable bowel syndrome. Gut. 2000;47:804–11.PubMedPubMedCentralGoogle Scholar
  71. 71.
    Mac Sharry J, O’Mahony L, Fanning A, et al. Mucosal cytokine imbalance in irritable bowel syndrome. Scand J Gastroenterol. 2008;43:1467–76.Google Scholar
  72. 72.
    Chadwick VS, Chen W, Shy D, Paulus B, Bethwaite P, Tie A, Wilson I. Activation of the mucosal immune system in irritable bowel syndrome. Gastroenterology. 2002;122:1778–83.PubMedGoogle Scholar
  73. 73.
    Tornblom H, Lindberg G, Nyberg B, Veress B. Full-thickness biopsy of the jejunum reveals inflammation and enteric neuropathy in irritable bowel syndrome. Gastroenterology. 2002;123:1972–91.PubMedGoogle Scholar
  74. 74.
    Forshammar J, Isaksson S, Strid H, Stotzer PO, Sjovall H, Simren M, Ohman L. A pilot study of colonic B cells pattern in irritable bowel syndrome. Scand J Gastroenterol. 2008;29:1–6.Google Scholar
  75. 75.
    Ohman L, Lindmark AC, Isaksson S, Posserud I, Strid H, Sjovall H, Simren M. B-cell activation in patients with irritable bowel syndrome [IBS]. Neurogastroenterol Motil. 2009;21:644–50.PubMedGoogle Scholar
  76. 76.
    Schoepfer AM, Shaffer T, Seibold-Schmid B, Muller S, Seibold F. Antibodies to flagellin indicate reactivity to bacterial antigens in IBS patients. Neurogastroenterol Motil. 2008;20:1110–8.PubMedGoogle Scholar
  77. 77.
    Barbara G, Stanghellini V, De Giorgio R, et al. Activated mast cells in proximity to colonic nerves correlate with abdominal pain in irritable bowel syndrome. Gastroenterology. 2004;126:693–702.PubMedGoogle Scholar
  78. 78.
    Barbara G, Wang B, Stanghellini V, et al. Mast cells-dependent excitation of visceral–nociceptive sensory neurons in irritable bowel syndrome. Gastroenterology. 2007;132:26–7.PubMedGoogle Scholar
  79. 79.
    Akbar A, Yiangou Y, Facer P, Walters JR, Anand P, Ghosh S. Increased capsaicin receptor TRPV1-expressing sensory fibers in irritable bowel syndrome and their correlation with abdominal pain. Gut. 2008;57:923–9.PubMedPubMedCentralGoogle Scholar
  80. 80.
    Hasler WL. Lactulose breath testing, bacterial overgrowth and IBS: just a lot of hot air? Gastroenterology. 2003;125:1895–900.Google Scholar
  81. 81.
    Shah ED, Bassen RJ, Chong K, Pimental M. Abnormal breath testing in IBS: a meta-analysis. Digest Dis Sci. 2010;55:2441–9.PubMedGoogle Scholar
  82. 82.
    Yu D, Cheeseman F, Vanner S. Combined ora–cecal scintigraphy and lactulose hydrogen breath testing demonstrates that breath testing detects oro–cecal transit, not small intestinal overgrowth in patients with IBS. Gut. 2011;60:334–40.PubMedGoogle Scholar
  83. 83.
    Posserud I, Stotzer P-D, Bjornsson ES, Abramsson H, Simren M. Small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Gut. 2007;56:802–8.PubMedPubMedCentralGoogle Scholar
  84. 84.
    Ford AS, Spiegel BM, Tally NJ, Moayyed P. Small intestinal bacterial overgrowth in irritable bowel syndrome: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2009;7:279–86.Google Scholar
  85. 85.
    Chuong RS, Ruff KC, Malhota A, et al. Clinical predictors of small intestinal bacterial overgrowth by duodenal aspirate culture. Aliment Pharmacol Ther. 2011;33:1059–67.Google Scholar
  86. 86.
    Pimental M, Chang C. Inflammation and microflora. Gastroenterol Clin North Am. 2011;40:69–85.Google Scholar
  87. 87.
    Attaluri A, Jackson M, Valestin J, et al. Methanogenic flora is associated with altered colonic transit but not stool characteristics in constipation without IBS. Am J Gastroenterol. 2010;105:1407–11.PubMedGoogle Scholar
  88. 88.
    Festi D, Schiumerini R, Birtolo C, et al. Gut microbiota and its pathophysiology in disease paradigms. Dig Dis. 2011;29:518–24.PubMedGoogle Scholar
  89. 89.
    Stanghellini V, Barbara G, Cremon C, et al. Gut microbiota and related diseases: clinical features. Intern Emerg Med. 2010;5 Suppl 1:S57–63.PubMedGoogle Scholar
  90. 90.
    Lyte M. The microbial organ in the gut as a driver of homeostasis and disease. Med Hypotheses. 2010;74:634–8.PubMedGoogle Scholar
  91. 91.
    Zoetendal EG, Akkermans AD, De Vos WM. Temperature gradient gel electrophoresis analysis of 16S rRNA from human fecal samples reveals stable and host-specific communities of active bacteria. Appl Environ Microbiol. 1998;64:3854–9.PubMedPubMedCentralGoogle Scholar
  92. 92.
    Claesson MJ, Cusak S, O’Sullivan O, et al. Composition, variability, and temporal stability of the intestinal microbiota of the elderly. Proc Natl Acad Sci U S A. 2011;108 Suppl 1:4586–91.PubMedPubMedCentralGoogle Scholar
  93. 93.
    Camp JG, Kanther M, Semova I, Rawls JF. Patterns and scales in gastrointestinal microbial ecology. Gastroenterology. 2009;136:1989–2002.PubMedGoogle Scholar
  94. 94.
    Frank DN, ST. Amand AL, Feldman RA, et al. Molecular phylogenetic characterization of microbial community imbalances in human inflammatory bowel disease. Proc Natl Acad Sci U S A. 2007;104:13780–5.PubMedPubMedCentralGoogle Scholar
  95. 95.
    Eckburg PB, Bik EM, Bernstein CN, et al. Diversity of the human intestinal microbial flora. Science. 2005;308:1635–8.PubMedPubMedCentralGoogle Scholar
  96. 96.
    Salonen A, de Vos WM, Palva A. Gastrointestinal microbiota in irritable bowel syndrome: present state and perspectives. Microbiology. 2010;156:3205–15.PubMedGoogle Scholar
  97. 97.
    Matto J, Maunukseh L, Kajunder K, Palva A, Korpela R, Kassinen A, Saarela M. Composition and temporal stability of gastrointestinal microbiota in irritable bowel syndrome – a longitudinal study in IBS and control subjects. FEMS Immunol Med Microbiol. 2005;43:213–22.PubMedGoogle Scholar
  98. 98.
    Maukonen J, Satokari R, Matto J, Soderlund H, Mattila-Sandholm T, Saarela M. Prevalence and temporal stability of the selected clostridial groups in irritable bowel syndrome in relation to predominant fecal bacteria. J Med Microbiol. 2006;55:625–33.PubMedGoogle Scholar
  99. 99.
    Malinen E, Rintilla T, Kajander K, 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.PubMedGoogle Scholar
  100. 100.
    Kassinen A, Kroggius-Kurrika L, Makkiviokko H, et al. The fecal microbiota of irritable bowel syndrome patients differs significantly from that of healthy subjects. Gastroenterology. 2007;133:24–33.PubMedGoogle Scholar
  101. 101.
    Lyra A, Rintilla T, Nikkila J, et al. Diarrhea-predominant irritable bowel syndrome distinguishable by 16S rRNA gene phylotype quantitation. World J Gastroenterol. 2009;15:5936–45.PubMedPubMedCentralGoogle Scholar
  102. 102.
    Krogius-Kunikka L, Lyra A, Malinen E, et al. Microbial community analysis reveals higher level phylogenetic alterations in the overall gastrointestinal microflora of diarrhea-predominant irritable bowel syndrome sufferers. BMC Gastroenterol. 2009;9:95.Google Scholar
  103. 103.
    Kerckhoffs APM, Samson M, van der Rest ME, de Vogel J, Knol J, Ben-Amor K, Akkemano LMA. Lower Bifidobacteria counts in both duodenal mucosa-associated and fecal microbiota in irritable bowel syndrome patients. World J Gastroenterol. 2009;15:2887–92.PubMedPubMedCentralGoogle Scholar
  104. 104.
    Noor SO, Ridgeway K, Scovell L, et al. Ulcerative colitis and irritable bowel syndrome exhibit distinct abnormalities of the gut microbiota. BMC Gastroenterol. 2010;10:134.PubMedPubMedCentralGoogle Scholar
  105. 105.
    Codling C, O’Mahony L, Sharahan F, Quigley EM, Marchesi JR. A molecular analysis of fecal bacterial communities in irritable bowel syndrome. Dig Dis Sci. 2010;55:392–7.PubMedGoogle Scholar
  106. 106.
    Tana C, Umesaki Y, Imaoka A, Handa T, Kanazawa M, Fukudo S. Altered profiles of intestinal microbiota and organic acids may be the origin of symptoms in irritable bowel syndrome. Neurogastroenterol Motil. 2010;22:512–9.PubMedGoogle Scholar
  107. 107.
    Ponnusamy K, Choi JN, Kim J, Lee SY, Lee CH. Microbial community and metabolomic comparisons of irritable bowel syndrome feces. J Med Microbiol. 2011;60:817–27.PubMedPubMedCentralGoogle Scholar
  108. 108.
    Carroll IM, Ringel-Kulla T, Keku TO, Chang YH, Packey CD, Sartor RB, Ringel Y. Molecular analysis of the luminal-and mucosal-associated intestinal microbiota of diarrhea-predominant irritable bowel syndrome. Am J Physiol Gastrointest Liver Physiol. 2011;301:G799–807.PubMedPubMedCentralGoogle Scholar
  109. 109.
    Saulner DM, Riehle K, Mistretta TA, et al. Gastrointestinal microbial signatures of pediatric patients with irritable bowel syndrome. Gastroenterology. 2011;141:1782–91.Google Scholar
  110. 110.
    Rajilic-Stojanovic M, Biagi E, Heilig HG, Kajander K, Kekkonen RA, Tims S, Devos WM. Global and deep molecular analysis of microbiota signatures in the fecal samples from patients with irritable bowel syndrome. Gastroenterology. 2011;141:1792–801.PubMedGoogle Scholar
  111. 111.
    Parkes GC, Rayment NB, Hudspith BN, et al. Distinct microbial population exists in the mucosa associated microbiota of subgroups of irritable bowel syndrome. Neurogastroenterol Motil. 2012;24:31–9.PubMedGoogle Scholar
  112. 112.
    Le Gall G, Noor SO, Ridgway K, et al. Metabolomics of fecal extracts detects altered metabolic activity of gut microbiota in ulcerative colitis and irritable bowel syndrome. J Proteome Res. 2011;10:4208–18.PubMedGoogle Scholar
  113. 113.
    Collins SM, Berick P. The relationship between intestinal microbiota and the central nervous system in normal gastrointestinal function and disease. Gastroenterology. 2009;136:2003–14.PubMedGoogle Scholar
  114. 114.
    Pimental M, Chatterjee S, Chang C, et al. A new rat model links two contemporary theories in irritable bowel syndrome. Dig Dis Sci. 2008;53:982–9.Google Scholar
  115. 115.
    Morales N, Pimental M, Hwang L, et al. Acute and chronic histological changes in the small bowel secondary to Campylobacter jejuni in a rat model of post-infectious IBS. Dig Dis Sci. 2011;56:2575–84.PubMedGoogle Scholar
  116. 116.
    Lbeakanma C, Orchoa–Cortes F, Miranda-Morales M, et al. Brain gut interaction increases peripheral nociceptive signaling in mice with post-infection irritable bowel syndrome. Gastroenterology. 2011;14:2098–108.Google Scholar
  117. 117.
    Keating C, Pelegrin P, Martinez CM, Grundy D. Pzx7 receptor-dependent afferent hypersensitivity in a mouse model of post-infectious irritable bowel syndrome. J Immunol. 2011;187:1467–74.PubMedGoogle Scholar
  118. 118.
    Baj K, Khaldi S, Gargala G, et al. Effects of octreotide on jejunal hypersensitivity triggered by Cryptosporidium parvum intestinal infection in an immunocompetent suckling rat model. Neurogastroenterol Motil. 2011;23:1043–50.Google Scholar
  119. 119.
    Qin HY, Wu JCY, Tong X-D, Sung JJY, Xu H-X, Bian Z-X. Systematic review of animals of post-infectious/post-inflammatory irritable bowel syndrome. J Gastroenterol. 2011;46:164–74.PubMedGoogle Scholar
  120. 120.
    Brandt LJ, Chey WD, Foxx-Orenstein AE, et al. An evidence-based systematic review on the management of irritable bowel syndrome. Am J Gastroenterol. 2009;104 Suppl 1:S1–35.PubMedGoogle Scholar
  121. 121.
    Cash BD, Chey WD. Advances in the management of irritable bowel syndrome. Curr Gastroenterol Rep. 2003;5:468–75.PubMedGoogle Scholar
  122. 122.
    Pimental M, Chow EJ, Lin HC. Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome: a double blind, randomized, and placebo-controlled study. Am J Gastroenterol. 2003;98:412–9.Google Scholar
  123. 123.
    Attar A, Flourie B, Rambaud J-C, Franchisseur C, Ruszniewski P, Bouchnik Y. Antibiotic efficacy in small intestinal bacterial overgrowth-related chronic diarrhea: a cross over-randomized trial. Gastroenterology. 1999;117:794–7.PubMedGoogle Scholar
  124. 124.
    Mc Evoy GK, Snow EK, Miller J, editors. Rifaximin. AHFS-drug information. Bethesda, MD: Am. Soc. Health Sys. Pharmacists; 2011. p. 499–501.Google Scholar
  125. 125.
    Pimental M, Park S, Mirocha J, Kane SV, Kong Y. The effect of a nonabsorbed oral antibiotic [rifaximin] on the symptoms of irritable bowel syndrome: a randomized trial. Ann Intern Med. 2006;145:457–63.Google Scholar
  126. 126.
    Shvara AI, Aoun E, Abdul-Baki H, Mounzer R, Sidani S, Elhajj I. A randomized double-blind placebo controlled trial of rifaximin in patients with abdominal bloating and flatulence. Am J Gastroenterol. 2006;101:326–33.Google Scholar
  127. 127.
    Pimental M, Lembo A, Chey WD, et al. Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med. 2011;364:22–32.Google Scholar
  128. 128.
    Fong IW. Probiotics in infectious diseases. Emerging issues and controversies in infectious diseases. New York, NY: Springer; 2009. p. 227–60.Google Scholar
  129. 129.
    Preidis GA, Versalovic J. Targeting the human microbiome with antibiotics, probiotics, and prebiotics: gastroenterology enters the metagenomic era. Gastroenterology. 2009;136:2015–31.PubMedPubMedCentralGoogle Scholar
  130. 130.
    Mc Farland LV, Dublin S. Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World J Gastroenterol. 2008;14:2650–61.Google Scholar
  131. 131.
    Nikfar S, Rahimi R, Rahimi F, et al. Efficacy of probiotics in the irritable bowel syndrome: I. Meta-analysis of randomized, controlled trials. Dis Colon Rectum. 2008;51:1775–80.PubMedGoogle Scholar
  132. 132.
    Parkes GC, Sanderson JD, Whelan K. Treating irritable bowel syndrome with probiotics: the evidence. Proc Nutr Soc. 2010;69:187–94.PubMedGoogle Scholar
  133. 133.
    Ringel Y, Ringel-Kulka T. The rational and clinical effectiveness of probiotics in irritable bowel syndrome. J Clin Gastroenterol. 2011;45 Suppl 3:S145–8.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • I. W. Fong
    • 1
  1. 1.University of TorontoTorontoCanada

Personalised recommendations