Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy

The pathogenesis of irritable bowel syndrome (IBS), once thought to be largely psychogenic in origin, is now understood to be multifactorial. One of the reasons for this paradigm shift is the realization that gut dysbiosis, including small intestinal bacterial overgrowth (SIBO), causes IBS symptoms....

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Bibliographic Details
Published in:Gut and liver 2017, 11(2), , pp.196-208
Main Authors: Ghoshal, Uday C, Shukla, Ratnakar, Ghoshal, Ujjala
Format: Article
Language:English
Subjects:
Adult
Anti-Bacterial Agents - therapeutic use
bacterial overgrowth
Biopsy - methods
Blind Loop Syndrome - diagnosis
Blind Loop Syndrome - microbiology
Blind Loop Syndrome - therapy
breath tests
Breath Tests - methods
dysbiosis
Female
gastrointestinal microbiota
Humans
Intestine, Small - microbiology
Intestine, Small - pathology
Irritable Bowel Syndrome - complications
Irritable Bowel Syndrome - microbiology
Male
Middle Aged
probiotics
Probiotics - therapeutic use
Review
rifaximin
Risk Factors
내과학
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Summary:The pathogenesis of irritable bowel syndrome (IBS), once thought to be largely psychogenic in origin, is now understood to be multifactorial. One of the reasons for this paradigm shift is the realization that gut dysbiosis, including small intestinal bacterial overgrowth (SIBO), causes IBS symptoms. Between 4% and 78% of patients with IBS and 1% and 40% of controls have SIBO; such wide variations in prevalence might result from population differences, IBS diagnostic criteria, and, most importantly, methods to diagnose SIBO. Although quantitative jejunal aspirate culture is considered the gold standard for the diagnosis of SIBO, noninvasive hydrogen breath tests have been popular. Although the glucose hydrogen breath test is highly specific, its sensitivity is low; in contrast, the early-peak criteria in the lactulose hydrogen breath test are highly nonspecific. Female gender, older age, diarrhea-predominant IBS, bloating and flatulence, proton pump inhibitor and narcotic intake, and low hemoglobin are associated with SIBO among IBS patients. Several therapeutic trials targeting gut microbes using antibiotics and probiotics have further demonstrated that not all symptoms in patients with IBS originate in the brain but rather in the gut, providing support for the micro-organic basis of IBS. A recent proof-of-concept study showing the high frequency of symptom improvement in patients with IBS with SIBO further supports this hypothesis.
ISSN:1976-2283
2005-1212
DOI:10.5009/gnl16126