| Workshop 12(JSGE・JSH・JSGCS) |
| Fri. November 22nd 9:00 - 11:20 Room 4: Portopia Hotel South Wing Portopia Hall |
| Gut microbiota-directed treatment of irritable bowel syndrome | |||
| Uday Chand Ghoshal | |||
| Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences | |||
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| Understanding of irritable bowel syndrome (IBS), once thought to be largely psychogenic, is rapidly changing. One reason for such paradigm shift is the realization that gut dysbiosis, which include qualitative and quantitative change in gut microbiota (small intestinal bacterial overgrowth, SIBO) may be important determinant of IBS symptoms, somewhat similar to that with peptic ulcer, thought to be related to psychological factor initially, but later proved to be due to infection with Helicobacter pylori. 4% to 78% patients with IBS and 1% to 40% controls have SIBO; such wide variations in prevalence might be related to geographical origin of studied population, IBS diagnostic criteria, and most importantly, methods to diagnose SIBO. More recently, several studies demonstrated alteration in fecal and small bowel microbiota using 16sRNA gene sequencing among patients with IBS compared to healthy subjects. There has been studies recently that gut microbiota may influence visceral sensation and brain function. Some of the psychological disturbances in patients with IBS might also be related to altered gut microbiota and its manipulation may improve mental function. Several therapeutic trials targeting gut microbes using antibiotics, probiotics, and fecal transplantation further proved the concept. TARGET 1 and 2 study showed that rifaximin is more effective than placebo in treatment of IBS. A recent proof of the concept study showing high frequency of symptom improvement among patients with IBS with SIBO further supports the role of gut microbiota in IBS. Of the two randomized controlled trials on fecal transplantation in patients with IBS, one showed its efficacy. Psychological dysfunction is well-known to be associated with IBS and gut microbial manipulation has been shown to improve brain function in these patients. Recent studies showing improvement of symptoms of IBS by dietary manipulation might be partly mediated by microbial alteration. |
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Index Term 1: Rifaximin Index Term 2: Functional gastrointestinal disorder |
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