Animal studies have demonstrated that changes in the gut microbiota result in altered host function, in domains relevant to IBS (gut motility, visceral pain responses, intestinal permeability, and brain function and behaviour)
Gut microbiota composition is altered in at least a subset of patients with IBS (most commonly diarrhoea-predominant IBS), but no microbial 'signature' that could act as an IBS biomarker has been identified
Considerable interest exists in the ability of bacteria to produce substances that interact with the host to influence gut and brain function, which include fatty acids, tryptophan and neurotransmitters
Dysbiosis in IBS is characterized by a loss of microbial diversity and temporal instability; contributing factors include diet, stress, infection, antibiotic usage, immune activation and low-grade inflammation
The gut microbiota from patients with IBS, but not healthy individuals, can induce gut dysfunction in mice reminiscent of that seen in IBS, strongly suggesting that the microbiota contributes to the expression of IBS
Emerging evidence supports the efficacy of select and limited microbiota-directed therapies in treating IBS, and to date these include prebiotics, probiotics and selected antibiotics
The past decade has witnessed an explosion of knowledge regarding the vast microbial community that resides within our intestine—the gut microbiota. The topic has generated great expectations in terms of gaining a better understanding of disorders ranging from IBD to metabolic disorders and obesity. IBS is a condition for which investigators have long been in search of plausible underlying pathogeneses and it is inevitable that altered composition or function of the gut microbiota will be considered as a potential aetiological factor in at least a subset of patients with IBS. This Review describes the evidence implicating the gut microbiota in not only the expression of the intestinal manifestations of IBS, but also the psychiatric morbidity that coexists in up to 80% of patients with IBS. The evidence described herein ranges from proof-of-concept studies in animals to observational studies and clinical trials in humans. The gut microbiota is subject to influences from a diverse range of factors including diet, antibiotic usage, infection and stress. These factors have previously been implicated in the pathophysiology of IBS and further prompt consideration of a role for the gut microbiota in IBS.
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S.M.C. acknowledges the Canadian Institutes for Health Research for support of his research cited in this Review. S.M.C. is the recipient of the GlaxoSmithKline Chair in Gastroenterology Research and a founding member of the Farncombe Family Digestive Health Research Institute at McMaster University, Canada.
S.M.C. receives a grant in aid from the Nestle Research Centre, Switzerland, and consults for Salix Inc.
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Collins, S. A role for the gut microbiota in IBS. Nat Rev Gastroenterol Hepatol 11, 497–505 (2014). https://doi.org/10.1038/nrgastro.2014.40