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The power of your gut

Irritable Bowel Syndrome and microbiota: is there a link?

IBS
The gut microbiota Irritable bowel syndrome (IBS) Functional gastrointestinal disorders Anxiety disorders Mood disorders Infectious gastroenteritis Liver diseases Probiotics Fecal transplant

To increase awareness about Irritable Bowel Syndrome (IBS), the Microbiota Institute is handing the floor to an expert in the field, Pr. Premysl Bercik, clinician and researcher at McMaster University, Canada.
What are the symptoms? Why do I develop IBS? Is it linked to the microbiota? Is there a microbiota-gut-brain axis? All your questions answered here.

The power of your gut
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This article is based on scientific information

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About this article

Author

Pr. Premysl Bercik Pr. Premysl Bercik

Professor in the Division of Gastroenterology and member of the Farncombe Family Digestive Health Research Institute at McMaster University, Canada. His research interest focuses on the role of intestinal bacteria in gut-brain axis in the context of gut function, low-grade inflammation and behavior, including anxiety and depression.

See the author
Created 06 April 2023
Updated 28 April 2023

Table of contents

Table of contents

What is Irritable Bowel Syndrome (IBS)?

IBS is a disorder of gut–brain interaction, which is characterized by chronic abdominal pain and altered bowel habit (changes in stool frequency or stool form) in the absence of any tissue damage. Gastrointestinal symptoms do not come alone as IBS is often accompanied by psychological upset (anxiety, stress or depression). 1

Find out more!
Irritable bowel syndrome (IBS)
Pr. Premysl Bercik

"During the last decade, increasing attention has been given to gut microbiota as a key player in IBS."

Pr. Premysl Bercik

How many people suffer from IBS?

Prof. Premysl Bercik: Data differ between countries, but it is estimated that IBS affects around 5 to 10% population globally. 2 Women are almost twice as likely as men to have IBS. They also report more fatigue and psychological distress. For both men and women, IBS can develop at any age, but its onset is often between age of 20 and 30.

5 to 10% It is estimated that IBS affects around 5 to 10% population globally.

2 out of 3 patients are women.

The quality of life of IBS patients is severely affected, interfering with their everyday life, frequently resulting in missing work or school. 3

Patients stories - logo 21.11.2022 Patients stories: living with Irritable Bowel Syndrome (IBS) Read more

What triggers IBS symptoms? Why do I develop IBS?

P.-B.: IBS is a complex disorder, its genesis is likely multifactorial and not fully understood. In general, it stems from impaired gut–brain interaction, a bidirectional communication between the digestive tract and the central nervous system. There are several peripheral mechanisms involved in IBS, including intestinal hypersensitivity, altered bowel motility, increased intestinal permeability and low-grade inflammation. In the brain, the signals from the bowel may be incorrectly interpreted and further magnified, and then the brain sends erroneous signals to the gut. During the last decade, increasing attention has been given to gut microbiota as a key player in IBS 4,5.

Axe intestin cerveau Bandeau 16.09.2019 How our gut constantly talks to our brain Read more

What is the scientific evidence for the involvement of the gut microbiota in IBS?

P.-B.: There are several lines of evidence that implicate microbiota in IBS:

  • First, bowel infection (gastroenteritis) is the strongest risk factor for IBS, with 11-14% of patients developing chronic symptoms after acute infection with pathogenic bacteria (Salmonella, E. coli or Campylobacter infection). 6
  • Second, clinical studies showed that microbiota-directed treatments affect IBS symptoms. Indeed, certain antibiotics improve symptoms in some patients with IBS, while in asymptomatic individuals they can trigger IBS symptoms. Specific probiotics were shown to improve symptoms of IBS, such as abdominal pain, diarrhea or bloating, although there is currently no consensus on which probiotics to recommend in clinical practice. 2
  • Third, gut microbial composition and metabolic activity differ between IBS patients and healthy individuals, and associate not only with bowel symptoms, but also with anxiety and depression. However, the results from individual studies vary and there seems to be no unique microbial profile that could be attributed to IBS. 7
  • Finally, and most importantly, several studies have shown that gut dysfunction and associated anxiety can be transferred through microbiota transplantation from IBS patients into germ-free mice. 8,9,10

Irritable Bowel Syndrome (IBS): what is the role of the microbiota?

Learn more

You’ve talked about gut-brain interaction. Is there a microbiota-gut-brain axis?

P.-B.: The gut-brain axis involves immune, neural and hormonal signaling and growing evidence suggests that the gut microbiota plays a key role in this communication. Although most data have been obtained from animal studies, many clinical studies support this concept. 11 Just to mention few, sudden changes in behavior have been described in patients treated with antibiotics. A recent population-based study found that use of antibiotics in early childhood is associated with an increased risk of developing mental health disorders in later life. The most obvious case comes from patients with end-stage liver disease (cirrhosis), diagnosed with (sidenote: Hepatic encephalopathy (HE) Hepatic encephalopathy (HE) refers to changes in the brain that occur in patients with advanced, acute (sudden) or chronic (long-term) liver disease. It is one of the major complications of cirrhosis. https://britishlivertrust.org.uk/information-and-support/living-with-a-liver-condition/liver-conditions/hepatic-encephalopathy/ ) These patients display altered behavior and cognition which improve quickly and dramatically after administration of antibiotics or laxatives, or fecal microbiota transplantation 12. And multiple studies found that the microbial profiles differ between patients with psychiatric disorders and healthy individuals. 13

5 take home messages for Irritable Bowel Syndrome (IBS):

  1. IBS is characterized by abdominal pain and altered bowel habits.
     
  2. Its prevalence is around 5 to 10%, predominantly affecting women, it has a significant socio-economic impact.
     
  3. Its pathophysiology is not fully understood, it is considered to be a disorder of the gut-brain interaction.
     
  4. Accumulating animal and clinical data suggest that gut bacteria are involved in cognition, behavior and mood disorders (depression, anxiety…).
     
  5. Several lines of evidence implicate gut microbiota in IBS:
  • Bacterial gastroenteritis is the most significant risk factor for IBS.
  • Microbiota-directed treatments (antibiotics, probiotics) can improve IBS symptoms.
  • Microbiota profiles and metabolism differ in patients with IBS and healthy individuals.
  • Transfer of microbiota from patients with IBS induces gut dysfunction and altered behavior in germ-free mice.

Can we modulate the gut microbiota to improve mental health?

P.-B.: In animal models, certain probiotics have shown beneficial effects on behavior and brain chemistry, suggesting they could be used therapeutically in mental disorders. The results of the few clinical studies completed so far suggest that probiotics, if used as an adjunctive treatment, improve symptoms in patients with major depressive disorder. 13 And our recent pilot study found that probiotic treatment improved depression scores and bowel symptoms in patients with IBS, and changed their brain activation patterns. 14 Altogether, this suggest that some probiotics could be helpful not only for patients with functional bowel disorders, but also for those with mental health issues. However, this needs to be confirmed by larger rigorous clinical studies.

Image
Photo: Pr. Premyl Bercik - Youtube video (EN)

BMI-23.14

Please note

The Biocodex Microbiota Institute’s goal is to educate the general public and healthcare professionals about the human microbiota. It does not provide medical advice. Please consult a health professional for any questions or requests you may have.

Sources

1. Lacy BE, Pimentel M, Brenner DM, et al. ACG Clinical Guideline: Management of Irritable Bowel Syndrome. Am J Gastroenterol. 2021;116(1):17-44.

2. Ford AC, Sperber AD, Corsetti M, et al. Irritable bowel syndrome. Lancet. 2020 Nov 21;396(10263):1675-1688.

3. Black CJ, Ford AC. Global burden of irritable bowel syndrome: trends, predictions and risk factors. Nat Rev Gastroenterol Hepatol 2020; 17: 473-86.

4. Simrén, M., Tack, J. New treatments and therapeutic targets for IBS and other functional bowel disorders. Nat Rev Gastroenterol Hepatol 15, 589–605 (2018).

5. Moayyedi P, Mearin F, Azpiroz F, et al. Irritable bowel syndrome diagnosis and management: A simplified algorithm for clinical practice. United European Gastroenterol J. 2017;5(6):773-788.

6. Barbara G, Grover M, Bercik P, et al. Rome Foundation Working Team Report on Post-Infection Irritable Bowel Syndrome. Gastroenterology. 2019;156(1):46-58.e7.

7. Pittayanon R, Lau JT, Yuan Y. Gut Microbiota in Patients With Irritable Bowel Syndrome-A Systematic Review. Gastroenterology. 2019;157(1):97-108.

8. De Palma G, Lynch MD, Lu J, et al. Transplantation of fecal microbiota from patients with irritable bowel syndrome alters gut function and behavior in recipient mice. Sci Transl Med 2017;9(379):eaaf6397.

9. Constante M, De Palma G, Lu J, . Saccharomyces boulardii CNCM I-745 modulates the microbiota-gut-brain axis in a humanized mouse model of Irritable Bowel Syndrome. Neurogastroenterol Motil 2021;33(3):e13985.

10. De Palma G, Shimbori C, Reed DE, et al. Histamine production by the gut microbiota induces visceral hyperalgesia through histamine 4 receptor signaling in mice. Sci Transl Med. 2022;14(655):eabj1895.

11. Morais LH, Schreiber HL 4th, Mazmanian SK. The gut microbiota-brain axis in behaviour and brain disorders. Nat Rev Microbiol. 2021;19(4):241-255.

12. Acharya C, Bajaj JS. Chronic Liver Diseases and the Microbiome-Translating Our Knowledge of Gut Microbiota to Management of Chronic Liver Disease. Gastroenterology 2021;160(2):556-572.

13. Nikolova VL, Cleare AJ, Young AH, et al. Updated Review and Meta-Analysis of Probiotics for the Treatment of Clinical Depression: Adjunctive vs. Stand-Alone Treatment. J Clin Med 2021;10(4):647.

14. Pinto-Sanchez MI, et al. Probiotic Bifidobacterium longum NCC3001 Reduces Depression Scores and Alters Brain Activity: A Pilot Study in Patients With Irritable Bowel Syndrome. Gastroenterology 2017;153(2):448-459.

Tags
IBS Irritable bowel syndrome Gut health Gut microbiota Gut-brain axis Dysbiosis FGIDs Abdominal pain Bloating Diarrhea Constipation

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    See also

    Faecal microbiota transplantation: a new treatment for irritable bowel syndrome?
    Photo: Irritable bowel syndrome (IBS) - disease page Irritable bowel syndrome (IBS)
    Created 06 April 2023
    Updated 28 April 2023

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    Irritable bowel syndrome (IBS) Functional gastrointestinal disorders Anxiety disorders Mood disorders Infectious gastroenteritis Liver diseases Probiotics Fecal transplant

    Author

    Pr. Premysl Bercik Pr. Premysl Bercik

    Professor in the Division of Gastroenterology and member of the Farncombe Family Digestive Health Research Institute at McMaster University, Canada. His research interest focuses on the role of intestinal bacteria in gut-brain axis in the context of gut function, low-grade inflammation and behavior, including anxiety and depression.

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