The DOI matches its Crossref record; 318 of the 318 references it cites were found in a registry or an index; 10 of the 186 sources its claims cite were checked for support.
Gut microbiota role in irritable bowel syndrome: New therapeutic strategies
Open accessAbstract
In the last decade the impressive expansion of our knowledge of the vast microbial community that resides in the human intestine, the gut microbiota, has provided support to the concept that a disturbed intestinal ecology might promote development and maintenance of symptoms in irritable bowel syndrome (IBS). As a correlate, manipulation of gut microbiota represents a new strategy for the treatment of this multifactorial disease. A number of attempts have been made to modulate the gut bacterial composition, following the idea that expansion of bacterial species considered as beneficial (Lactobacilli and Bifidobacteria) associated with the reduction of those considered harmful (Clostridium, Escherichia coli, Salmonella, Shigella and Pseudomonas) should attenuate IBS symptoms. In this conceptual framework, probiotics appear an attractive option in terms of both efficacy and safety, while prebiotics, synbiotics and antibiotics still need confirmation. Fecal transplant is an old treatment translated from the cure of intestinal infective pathologies that has recently gained a new life as therapeutic option for those patients with a disturbed gut ecosystem, but data on IBS are scanty and randomized, placebo-controlled studies are required.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
This narrative review argues that disturbed gut microbiota contributes to irritable bowel syndrome (IBS) and that microbiota manipulation is a promising therapeutic strategy. Probiotics have the most supportive evidence, while prebiotics, synbiotics, antibiotics, and fecal microbiota transplantation require further randomized controlled trials.
Key findings
- IBS affects 10%-15% of the general population, and most data support altered luminal and mucosal microbiota in IBS subgroups versus healthy individuals, including decreased Lactobacilli and Bifidobacteria, increased aerobes, and higher mucosal bacteria; a high Firmicutes:Bacteroidetes ratio is found in some IBS patients and appears to correlate with depression and anxiety.
- Probiotics show the strongest evidence: Moayyedi et al examined 18 RCTs including 1650 IBS patients and found probiotics significantly better than placebo for overall symptoms, with significant improvement in pain, flatulence, and bloating but not urgency; Hungin et al selected 19 studies including 1807 patients and reported responder rates of 18%-80% in IBS versus 5%-50% in healthy controls, with a favorable safety profile.
- Didari et al meta-analyzed 15 trials including 882 patients with D-IBS, C-IBS, and A-IBS and found probiotics more effective than placebo in reducing abdominal pain after 8 and 10 wk, with a higher effect at week 8; Table 2 grades evidence as high for global symptom relief and abdominal pain, moderate for bloating/distension, bowel habit, and quality of life, low for constipation and flatus, and very low for diarrhea.
- Rifaximin evidence comes from TARGET 1 and TARGET 2, which included 1260 patients with IBS without constipation: adequate relief of global IBS symptoms was 40.7% vs 31.7% for rifaximin vs placebo, and adequate relief of bloating, abdominal pain, and stool consistency was 40.2% vs 30.2%; FMT data are limited, with Borody et al reporting approximately 50% symptom relief in an early case series and Pinn et al reporting 70% resolution or improvement in refractory IBS patients.
Methods
- Narrative review; no primary data are presented.
- The paper synthesizes human microbiota studies in IBS and therapeutic trials, including meta-analyses and RCTs; for probiotics, it focuses on meta-analyses and extensive reviews published in the last 5 years that screened RCTs in IBS patients.
- Main analysis is qualitative synthesis of microbiota alterations and therapeutic evidence; no formal systematic search strategy or quantitative pooling is described.
Limitations
- The paper states that probiotic trials are highly heterogeneous, often have inadequate sample size, poor study design, and use various probiotic strains; meta-analyses recommend additional RCTs with appropriate endpoints and design.
- It states that prebiotic results are conflicting and may exacerbate IBS symptoms, synbiotic experience is limited with poor-quality studies, FMT data on IBS are scanty and randomized placebo-controlled studies are required, and rifaximin is effective in less than 50% of patients, has been studied mainly in non-constipated IBS, and has unknown long-term and microbiota effects.
- Evident from the text: as a narrative review, it does not report a systematic search, formal risk-of-bias assessment, or quantitative synthesis for most therapeutic sections.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
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Cites
Statistics
Verification
Claims the paper makes
101 Not checked yet · 23 Own interpretation · 8 No basis given · 2 Supported · 2 Mixed support · 1 Partly supported · accuracy not yet measured
Some cited sources support this claim and some don’t — read each source’s verdict below.
In the paper
“Probiotics tested to date do not help reduce flatus in patients with IBS Low [147,149-150,156,168,174-175, 178-179,184]”
What the sources say
- Not checked yetcites [147] source
- Partly supportedcites [149] sourceExperimental — accuracy not yet measured
The Discussion reports that VSL#3 had no effect on flatulence relative to placebo in patients with diarrhoea-predominant IBS. But it also reports a controlled trial in which Lactobacillus plantarum significantly improved flatulence. This paper therefore supports a null result for VSL#3, not the claim about probiotics tested to date; it does not assign a grade of evidence. (LLM, conf=0.88)
- Disputedcites [150] sourceExperimental — accuracy not yet measured
The Gastrointestinal symptoms results (p. 4) report that flatulence decreased in 68% of probiotic-treated patients versus 40% of placebo patients (P = 0.011), contrary to a blanket claim that probiotics do not help reduce flatus. The difference in mean flatulence scores was not statistically significant (Table 2, p. 5), so the paper's findings are mixed rather than uniformly negative. (LLM, conf=0.87)
Checked by a reasoning model — may be wrong.
- Not checked yetcites [156] source
- Not checked yetcites [168] source
- Not checked yetcites [174] source
- Not checked yetcites [175] source
- Not checked yetcites [178] Sen S, Mullan MM, Parker TJ, Woolner JT, Tarry SA, Hunter JO. Effect of Lactobacillus plantarum 299v on colonic fermentation and symptoms of irritable bowel syndrome. Dig Dis Sci 2002;47:2615-2620. source
- Partly supportedcites [179] sourceExperimental — accuracy not yet measured
The Secondary outcome measures table (p. 6) reports a larger reduction in flatulence with the probiotic than with placebo, but the between-group difference was not statistically significant (P = 0.11). This supports a lack of demonstrated benefit for the formulation tested in this trial, not the broader claim about all probiotics tested to date; the paper also does not assign a low evidence grade. (LLM, conf=0.85)
- Disputedcites [184] sourceExperimental — accuracy not yet measured
The Discussion (page unavailable) says that VSL #3 reduced flatulence scores in patients with IBS, contrary to the claim that probiotics tested to date do not help reduce flatus. The paper describes that benefit as relatively small, and its own Results do not report a significant flatulence benefit; neither point supports the claim's blanket wording. (LLM, conf=0.83)
Checked by a reasoning model — may be wrong.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Some cited sources support this claim and some don’t — read each source’s verdict below.
In the paper
“Specific probiotics may help reduce constipation in some patients with IBS Low [155-156,183,185]”
What the sources say
- Disputedcites [155] sourceExperimental — accuracy not yet measured
The Secondary endpoints section reports that B. bifidum MIMBb75 improved some IBS symptoms but that no effects were detected for bowel-movement frequency or incomplete evacuation. The Baseline characteristics section includes patients with constipation-predominant IBS, but the paper does not report that their constipation improved. The citing document’s low evidence grade is not assessed by this trial. (LLM, conf=0.85)
Checked by a reasoning model — may be wrong.
- Not checked yetcites [156] source
- Not checked yetcites [183] S Kim L, Hilli L, Orlowski J, Kupperman JL, Baral M, F Waters R. Efficacy of probiotics and nutrients in functional gastrointestinal disorders: a preliminary clinical trial. Dig Dis Sci 2006;51:2134-2144. source
- Partly supportedcites [185] sourceExperimental — accuracy not yet measured
The Results (Functional gastrointestinal symptom frequency; page unavailable) report that B. lactis HN019 reduced constipation symptom frequency more than placebo. The Participants section (page unavailable) describes adults selected by stool type and bowel-movement frequency, not patients diagnosed with IBS. The Discussion calls the trial Level I evidence; it does not establish the citing sentence’s low evidence grade for IBS. (LLM, conf=0.87)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Disputed
Every source the paper cites for this claim was checked and supports it.
In the paper
“Fourth, the intestinal microbiota strongly interacts with exogenous factors, in particular diet, which may directly or indirectly cause IBS symptoms [79] .”
What the sources say
- Supportedcites [79] Rajilić-Stojanović M, Jonkers DM, Salonen A, Hanevik K, Raes J, Jalanka J, de Vos WM, Manichanh C, Golic N, Enck P. Intestinal microbiota and diet in IBS: causes, consequences, or epiphenomena? Am J Gastroenterol 2015;110:278-287. source
The Introduction states nearly the same claim: the intestinal microbiota strongly interacts with exogenous factors, particularly diet, which may directly or indirectly provoke IBS symptoms. The Microbiota–Diet Interactions in IBS section also describes how microbial digestion of dietary components can produce metabolites that contribute to symptoms. (LLM, conf=0.95)
boostedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“which integrity is important in the pathogenesis of IBS [244,245]”
What the sources say
- Partly supportedcites [244] sourceExperimental — accuracy not yet measured
The introduction says HPA responses to stress may play a key role in the emergence and maintenance of IBS symptoms, and the Discussion says HPA hyperactivity might initiate or sustain IBS. These passages support the HPA axis’s relevance, but present its role in pathogenesis as a possibility rather than an established fact. Page numbers are unavailable in our copy. (LLM, conf=0.83)
- Supportedcites [245] source
The Introduction identifies altered HPA-axis function as a key pathophysiological feature of IBS. The Discussion likewise describes a recognized role for HPA-axis dysfunction in IBS pathophysiology, supporting the claim that its proper functioning matters. (LLM, conf=0.91)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“the probiotic mixture VSL#3 downregulated the colonic expression of several genes (i.e., TPH1, CCL2, CCR2, NOS3, NTRK1, BDKRB1, IL10, TNFRSF1B and TRPV4) encoding for proteins involved in nociception [214]”
What the sources say
- Supportedcites [214] source
The Results section states that all nine listed genes were significantly downregulated by VSL#3 in neonatal maternal separation (NMS) rats. The Discussion identifies them as encoding proteins involved in nociception, and the Methods specify that the gene-expression analysis used colonic samples. (LLM, conf=0.95)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
In the paper
“Furthermore, a higher degree of temporal instability of the microbiota among IBS patients has been detected.”
What the sources say
- Not checked yetcites [3963]
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Finally mucosal bacteria have also been found to be more abundant in IBS patients than in healthy controls (Table 1).”
What the sources say
- Not checked yetcites [3963]
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Second, it has been reported that approximately 10% of IBS patients refer that their symptoms began following an episode of infectious diarrhea [7577] , the so-called post infectious IBS (PI-IBS), a condition with a clear infective trigger that may alter the normal intestinal microbiota.”
What the sources say
- Not checked yetcites [7577]
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Indeed, probiotic administration was significantly better than placebo at improving overall symptoms.”
What the sources say
- Not checked yetcites [142] source
plaindirectn = 1,650- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“studies that have examined the effect of probiotics supplementation on fecal SCFAs in humans have provided conflicting results”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 31
- Probably not a substantial claim. 9
- The quote only partly states this claim. 1
In the paper
“Using culture-based techniques and a 16S rRNA gene-based phylogenetic microarray analysis, it has been demonstrated that the diversity of microbial population is reduced, the proportion of specific bacterial groups is altered and the degree of variability in the microbiota composition is different in IBS patients when compared with healthy subjects.”
What the sources say
- Not checked yetcites [3963]
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Examples of these modifications are a decreased amount of Lactobacilli and Bifidobacteria along with an increased amount of aerobes relatively to anaerobes in IBS patients.”
What the sources say
- Not checked yetcites [3963]
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Probiotics had a favorable safety profile with no difference in adverse events among the 23 specific probiotic treatments and placebo [173] .”
What the sources say
- Not checked yetcites [173] source
plainn = 1,807- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Moreover probiotics showed a statistically significant effect in improving individual symptoms such as pain, flatulence and bloating, but not urgency.”
What the sources say
- Not checked yetcites [142] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“studies demonstrating a strong correlation between the assumption of probiotics and the level of fecal SCFAs in IBS patients are lacking”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“However, few studies have evaluated the efficacy of prebiotics in IBS and existing results are conflicting.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“the effect of rifaximin on gut microbiota composition is essentially unknown”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“To date, only anecdotal data have been reported about the efficacy of FMT for IBS treatment, results being far conclusive.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“all metaanalysis point out to the weakness of the majority of the studies and recommend additional RCT trials to confirm the positive findings reported by small studies”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In this conceptual framework, probiotics appear an attractive option in terms of both efficacy and safety, while prebiotics, synbiotics and antibiotics still need confirmation.”
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“First, there is increasing evidence of an activation of the intestinal immune system in IBS leading in a micro-inflammation, with studies demonstrating increased concentrations of mucosal intraepithelial lymphocytes [65,66] , mast cells [6669] and 5hydroxytryptaminesecreting enterochromaffin cells [65] .”
What the sources say
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Consistent with this view, the clinical guidance regarding the modulation of intestinal microbiota in IBS provided by the Rome Team Working Group has recently concluded that there is good evidence supporting the concept that the intestinal microbiota is perturbed in patients with IBS [64] .”
What the sources say
- Not checked yetcites [64] source
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In irritable bowel syndrome (IBS), the altered composition and/or activity of microbiota may induce a disruption of this communication leading to activation of immune system and production of proinflammatory cytokines”
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
- Rests on an assumption: Mechanisms by which gut microbiota modulates motility, visceral sensitivity, and neuroimmune signaling in animal models also operate in human IBS.
None of the sources cited for this claim have been checked yet.
In the paper
“Nonetheless gut microbiota modulates gut motor function, which in turn can alter the intestinal microbiota composition.”
What the sources say
- Not checked yetcites [93] Caenepeel P, Janssens J, Vantrappen G, Eyssen H, Coremans G. Interdigestive myoelectric complex in germ-free rats. Dig Dis Sci 1989;34:1180-1184. source
- Not checked yetcites [94] source
- Not checked yetcites [95] Husebye E, Hellström PM, Midtvedt T. Intestinal microflora stimulates myoelectric activity of rat small intestine by promoting cyclic initiation and aboral propagation of migrating myoelectric complex. Dig Dis Sci 1994;39:946-956. source
- Not checked yetcites [96] Husebye E, Hellström PM, Sundler F, Chen J, Midtvedt T. Influence of microbial species on small intestinal myoelectric activity and transit in germ-free rats. Am J Physiol Gastrointest Liver Physiol 2001;280:G368-G380. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“However, it has been suggested that probiotics might reshape the intestinal ecosystem generating an ecological milieu that is unfavorable for the growth of harmful species by increasing the number of Lactobacilli and Bifidobacteria [199] that will stabilize the intestinal microbiota [174,179] .”
What the sources say
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: The clinical benefits of probiotics in IBS are mediated by their effects on gut microbiota composition or function.
In the paper
“as well as an increase in the tissue IL-10/IL-12 ratio ameliorating the quality of life of DIBS [232]”
What the sources say
- Not checked yetcites [232] source
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Saccharomyces boulardii supplementation induced a significant decrease in blood and tissue levels of proinflammatory cytokines IL8 and TNFa and an increase in antiinflammatory IL-10 levels”
What the sources say
- Not checked yetcites [232] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“the Bifidobacterium lactis Bb12 increased the fecal level of acetate and lactate in preterm infants [243]”
What the sources say
- Not checked yetcites [243] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“leading to en hanced production of SCFAs that are toxic at high concentrations and stimulate 5-HT release from the intestinal nerve endings [239]”
What the sources say
- Not checked yetcites [239] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“but also improved the immune environment of stressed animals and protected against stress induced disturbances in adult gut microflora [246]”
What the sources say
- Not checked yetcites [246] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“bifidobacteriafermented milk increased fecal butyrate, propionate and short-chain fatty acid concentrations but ameliorated symptoms in patients affects by UC [242]”
What the sources say
- Not checked yetcites [242] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Bifidobacterium animalis subsp lactis BB12 ® and Propionibacterium jensenii 702 induced activation of neonatal stress pathways and an imbalance in gut microflora”
What the sources say
- Not checked yetcites [246] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“There are evidence that the gut microbiota modulates the CNS via the ENS, the ANS, the HPA axis and vice versa [124,213]”
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“An intestinal dysbiosis may lead to alteration of brain-gut axis and probiotics may restore the normal interaction among all components of this pathway.”
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“long-chain polyunsaturated fatty acids have been tested as active prebiotics [254]”
What the sources say
- Not checked yetcites [254] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The clinical response may be dependent on the prebiotic type and dose, taking into account that low doses may be ineffective and high doses may stimulate colonic gas production.”
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“lactulose and bran, that are successfully used for constipation, tend to produce substantial amounts of gas and abdominal pain and may aggravate symptoms of IBS [269271]”
What the sources say
- Not checked yetcites [269271]
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“GOS lowering flatulence and bloating while also improving the anxiety score [83]”
What the sources say
- Not checked yetcites [83] Silk DB, Davis A, Vulevic J, Tzortzis G, Gibson GR. Clinical trial: the effects of a trans-galactooligosaccharide prebiotic on faecal microbiota and symptoms in irritable bowel syndrome. Aliment Pharmacol Ther 2009;29:508-518. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“fructose and sorbitol mixtures produce a modest increase in stool weight, they often increase flatulence and bloating in both healthy volunteers and IBS patients [272,273]”
What the sources say
- Not checked yetcites [272] Nelis GF, Vermeeren MA, Jansen W. Role of fructose-sorbitol malabsorption in the irritable bowel syndrome. Gastroenterology 1990;99:1016-1020. source
- Not checked yetcites [273] Symons P, Jones MP, Kellow JE. Symptom provocation in irritable bowel syndrome. Effects of differing doses of fructose-sorbitol. Scand J Gastroenterol 1992;27:940-944. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the limited experience and the poor quality of published studies do not allow any recommendation on their use in IBS”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“Few open label trials [64,279] and PCT studies have evaluated the efficacy of synbiotics in both functional pain [280] and IBS, all demonstrating a superiority of the probiotic/prebiotic combinations vs placebo [281283]”
What the sources say
- Not checked yetcites [64] source
- Not checked yetcites [279] Saneian H, Pourmoghaddas Z, Roohafza H, Gholamrezaei A. Synbiotic containing Bacillus coagulans and fructo-oligosaccharides for functional abdominal pain in children. Gastroenterol Hepatol Bed Bench 2015;8:56-65.
- Not checked yetcites [280] source
- Not checked yetcites [281283]
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“however, these drugs are absorbable causing local and systemic side effects”
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“a pooled analysis by Schoenfeld et al [292] has confirmed the safety and tolerability profile of rifaximin in comparison with placebo, with similar incidence of drug-related adverse events”
What the sources say
- Not checked yetcites [292] source
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“rifaximin has virtually no systemic absorption, is effective in improving IBS symptoms with low bacterial resistance profile and has a favorable sideeffects profile”
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“a large case series of CDI patients has showed rapid response and a cure rate of nearly 90%, without significant adverse event rate [295]”
What the sources say
- Not checked yetcites [295] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“however, the study also included IBD and CDI patients and did not show any distinction within the results between these different diseases”
What the sources say
- Not checked yetcites [305] Borody TJ, George L, Andrews P, Brandl S, Noonan S, Cole P, Hyland L, Morgan A, Maysey J, Moore-Jones D. Bowel-flora alteration: a potential cure for inflammatory bowel disease and irritable bowel syndrome? Med J Aust 1989;150:604. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“to date, probiotic supplementation and antimicrobial therapy with not absorbable antibiotics are promising treatment”
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“FMT might be a reasonable option for treating IBS, as it is an inexpensive and easy treatment”
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
The paper relies on this without support.
Mechanisms by which gut microbiota modulates motility, visceral sensitivity, and neuroimmune signaling in animal models also operate in human IBS.
“antibiotics-induced intestinal dysbiosis mo dified colonic painrelated and motor responses by upregulation of TLR4 and TLR7 and downregulation of the antinociceptive cannabinoid 1 and mu-opioid receptor in mice [115] .”
The paper relies on this without support.
The clinical benefits of probiotics in IBS are mediated by their effects on gut microbiota composition or function.
“probiotics have been shown effective in modulating several mechanisms that might have a mechanistic role in IBS pathogenesis, including effects on composition of intestinal microbiota”
The paper relies on this without support.
Heterogeneous probiotic trials can be pooled to support a general conclusion that probiotics are efficacious in IBS.
“although a number of metaanalysis or systemic reviews indicate that probiotics may be helpful in the treatment of IBS symptoms, their conclusions vary because of inadequate sample size, poor study design and use of various probiotic strains in the reviewed studies.”
The authors state this as an assumption.
IBS is characterized by impaired intestinal motor functions and by gas retention.
“From almost 4 decades, the assumption that IBS is characterized by impaired intestinal motor functions [205207] and by gas retention [208] has driven the treatment of IBS to small bowel and colonic dys motilities.”
The paper relies on this without support.
Persistence of IBS-like symptoms occurs in a small percentage of patients after a documented episode of intestinal bacterial or viral infection.
“it is widely accepted that persistence of IBS-like symptoms occurs in a small percentage of patients after a documented episode of intestinal bacterial or viral infection”
The paper relies on this without support.
IBS is characterized by increased intestinal permeability, a biomarker of impaired epithelial barrier function.
“animal and epidemiological studies indicate that IBS is characterized by an increased intestinal permeability, a biomarker of impaired epithelial barrier function”
The paper relies on this without support.
Probiotics have a short lifespan within the gut and need repeated doses to keep a constant level.
“An important safety feature of probiotics is that they have a short lifespan within the gut and need repeated doses to keep a constant level.”
The paper relies on this without support.
Alteration in the gut microbiota composition is a relevant pathogenetic factor in IBS.
“The alteration in the gut microbiota composition is increasingly considered to be a relevant pathogenetic factor in IBS, leading to the use of antibiotics as a treatment for this multifactorial syndrome.”
The paper relies on this without support.
Small intestinal bacterial overgrowth may be relevant to at least a subset of IBS patients.
“a SIBO may be relevant to at least a subset of IBS patients, thus justifying an antimicrobial approach”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“As previously stated, the long-term PPI use facilitates the induction of enteric infection, and, through secondary changes in microbiota composition, these drugs may influence gut–brain axis functions, prompting IBS onset[117,118].”
From Proton pump inhibitors and dysbiosis: current knowledge and aspects to be clarified (2019) · cites this paper as [117]
In the citing paper
“Patients with IBS with constipation also exhibit a higher proportion of Clostridium, Escherichia coli, Salmonella, Shigella, and Pseudomonas in the gut microbiota [13].”
From Chronic constipation and gut microbiota: current research insights and therapeutic implications (2024) · cites this paper as [13]
Citations
Cites
An obesity-associated gut microbiome with increased capacity for energy harvest
Turnbaugh, P. J., Ley, R. E., Mahowald, M. A., Magrini, V., Mardis, E. R., & Gordon, J. I. (2006) · Nature · doi:10.1038/nature05414 · Cited by 12,444
A human gut microbial gene catalogue established by metagenomic sequencing
MetaHIT Consortium, Qin, J., Li, R., Raes, J., Arumugam, M., Burgdorf, K. S., Manichanh, C., Nielsen, T., Pons, N., Levenez, F., et al. (2010) · Nature · doi:10.1038/nature08821 · Cited by 11,624
Hill (2014) · doi:10.1038/nrgastro.2014.66 · Cited by 9,592
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Ley, R. E., Turnbaugh, P. J., Klein, S., & Gordon, J. I. (2006) · Nature · doi:10.1038/4441022a · Cited by 8,785
Finishing the euchromatic sequence of the human genome
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Host-gut microbiota metabolic interactions
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Mind-altering microorganisms: the impact of the gut microbiota on brain and behaviour
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Induction of Intestinal Th17 Cells by Segmented Filamentous Bacteria
Ivanov, I. I., Atarashi, K., Manel, N., Brodie, E. L., Shima, T., Karaoz, U., Wei, D., Goldfarb, K. C., Santee, C. A., Lynch, S. V., et al. (2009) · Cell · doi:10.1016/j.cell.2009.09.033 · Cited by 4,554
Functional interactions between the gut microbiota and host metabolism
Tremaroli, V., & Bäckhed, F. (2012) · Nature · doi:10.1038/nature11552 · Cited by 4,387
Research works printed but not linked: 4
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- 10.1111/j.1365-2982.2011.01783 · DOI
- 10.7326/0003-4819-145-8200610170-00004 · DOI
Cited by
Sorted by citations
Khan, I., Ullah, N., Zha, L., Bai, Y., Khan, A., Zhao, T., Che, T., & Zhang, C. (2019) · Pathogens · doi:10.3390/pathogens8030126 · Cited by 771
Bifidobacteria and Their Health-Promoting Effects
Hidalgo-Cantabrana, C., Delgado, S., Ruiz, L., Ruas-Madiedo, P., Sánchez, B., & Margolles, A. (2017) · Microbiology Spectrum · doi:10.1128/microbiolspec.bad-0010-2016 · Cited by 490
Sex-gender differences in irritable bowel syndrome
Kim, Y. S., & Kim, N. (2018) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm18082 · Cited by 322
Gut Microbiota and Iron: The Crucial Actors in Health and Disease
Yilmaz, B., & Li, H. (2018) · Pharmaceuticals · doi:10.3390/ph11040098 · Cited by 317
Slyepchenko, A., Maes, M., Jacka, F. N., Köhler, C. A., Barichello, T., McIntyre, R. S., Berk, M., Grande, I., Foster, J. A., Vieta, E., et al. (2017) · Psychotherapy and Psychosomatics · doi:10.1159/000448957 · Cited by 278
Hoban, A. E., Moloney, R. D., Golubeva, A. V., McVey Neufeld, K. A., O’Sullivan, O., Patterson, E., Stanton, C., Dinan, T. G., Clarke, G., & Cryan, J. F. (2016) · Neuroscience · doi:10.1016/j.neuroscience.2016.10.003 · Cited by 270
Proton pump inhibitors and dysbiosis: current knowledge and aspects to be clarified
Bruno, G., Zaccari, P., Rocco, G., Scalese, G., Panetta, C., Porowska, B., Pontone, S., & Severi, C. (2019) · World Journal of Gastroenterology · doi:10.3748/wjg.v25.i22.2706 · Cited by 258
Altered microbiome composition in individuals with fibromyalgia
Minerbi, A., Gonzalez, E., Brereton, N. J. B., Anjarkouchian, A., Dewar, K., Fitzcharles, M.-A., Chevalier, S., & Shir, Y. (2019) · Pain · doi:10.1097/j.pain.0000000000001640 · Cited by 220
El Hage, R., Hernandez-Sanabria, E., & Van de Wiele, T. (2017) · Frontiers in Microbiology · doi:10.3389/fmicb.2017.01889 · Cited by 185
Irritable bowel syndrome diagnosis and management: A simplified algorithm for clinical practice
Moayyedi, P., Mearin, F., Azpiroz, F., Andresen, V., Barbara, G., Corsetti, M., Emmanuel, A., Hungin, A. P. S., Layer, P., Stanghellini, V., et al. (2017) · United European Gastroenterology Journal · doi:10.1177/2050640617731968 · Cited by 135
McKean, J., Naug, H., Nikbakht, E., Amiet, B., & Colson, N. (2017) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2016.0023 · Cited by 125
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Chronic constipation and gut microbiota: current research insights and therapeutic implications
Xu, X., Wang, Y., Long, Y., & Cheng, Y. (2024) · Postgraduate Medical Journal · doi:10.1093/postmj/qgae112 · Cited by 32
Metadata
- Authors
- Distrutti, E., Monaldi, L., Ricci, P., & Fiorucci, S.
- Affiliations
- University of Perugia (IT)
- Corresponding author
- Distrutti, Eleonora
- Venue
- World Journal of Gastroenterology
- Publisher
- Baishideng Publishing Group Inc.
- Published
- 2016-02-21
- Volume
- 22
- Issue
- 7
- Pages
- 2219-2241
- ISSN
- 1007-9327 (ISSN-L)
- PMC
- PMC4734998
- OpenAlex
- W2275770700
- Semantic Scholar
- 0efe65174da858617b153324292cf2bd638fa446
- Cited by
- 320
- References
- 318
- Citations by year
- 2026: 7 · 2025: 19 · 2024: 14 · 2023: 29 · 2022: 37 · 2021: 48 · 2020: 40 · 2019: 46 · 2018: 35 · 2017: 30 · 2016: 15
- FWCI
- 7.14
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- World Journal of Gastroenterology (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
- Keywords
- gut microbiota, irritable bowel syndrome, probiotics, prebiotics, synbiotics, fecal microbiota transplantation, lactobacilli, Bifidobacterium, dysbiosis, antibiotic therapy, treatment options
- MeSH terms
- Gastrointestinal Microbiome, Fecal Microbiota Transplantation, Animals, Anti-Bacterial Agents, Bacteria, Humans, Intestines, Treatment Outcome, Probiotics, Irritable Bowel Syndrome, Host-Pathogen Interactions, Prebiotics, Synbiotics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-09, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-09 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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