Irritable bowel syndrome (IBS) is characterized by painful digestive problems that are caused by dysbiosis.
IBS is the most common functional gastrointestinal disorder in children (40 to 45% of cases)1 .
Rome IV2 criteria are usually used to define the disease: clinical signs characterized by abdominal pain, bloating, and transit disorders, with either diarrhea, constipation, or even an alternation between the two.
Dysfunction associated to microbiota imbalance
In cases of IBS, a dysbiosis with less diversity has been described, particularly in the microbiota in contact with the mucosa, as well as an increase in certain Clostridia and Firmicutes (Veillonella) and a decrease in bifidobacteria, particularly in contact with the intestinal mucosa3. Dysbiosis promotes changes in the intestinal barrier. This increased permeability can cause low-grade intestinal inflammation characterized by an increase in immunocompetent cells and/or production of pro-inflammatory cytokines. These various elements contribute to increase the sensitivity of sensory afferents in the enteric nervous system (which explains the pain in these patients).
Largely symptomatic treatment
The basis for the therapeutic response is primarily pain management: antispasmodic medications with peripheral action are largely used.
Treatment for transit disorders should also be associated to treatment for pain. Dietary fiber, for example, is recommended in cases with primary constipation.
Probiotics are promising
Considering the disruptions in the microbiota identified in patients with IBS, the use of probiotics is an interesting therapeutic option: several randomized, placebo-controlled studies have demonstrated the effectiveness of Lactobacillus rhamnosus GG, in particular in reducing pain and abdominal distention in children presenting with irritable bowel syndrome5,6.
1. Helgeland H, Flagstad G, Grøtta J, Vandvik PO, Kristensen H, Markestad T. Diagnosing pediatric functional abdominal pain in children (4-15 years old) according to the Rome III Criteria: results from a Norwegian prospective study. J Pediatr Gastroenterol Nutr. 2009;49:309-15.
2. Drossman D. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology. 2016 Feb 19.
3. Simren M, Barbara G, Flint HJ, et al. Intestinal microbiota in functional bowel disorders: a Rome foundation report. Gut 2013 ; 62 : 159-76.
4. Camilleri M et al. Peripheral mechanisms in irritable bowel syndrome. NEJM 2012 ; 367 : 1626-35.
5. Gawronska A. et al. A randomized double-blind placebo-controlled trial of Lactobacillus GG for abdominal pain disorders in children. Aliment Pharmacol Ther. 2007; 25: 177-184.
6. Bausserman M. et al. The use of Lactobacillus GG in irritable bowel syndrome in children: a double-blind randomized control trial. J Pediatr. 2005; 147: 197-201.