Cited by 320Gastrointestinal motility and disordersGut microbiota and healthProbiotics and Fermented Foods

The DOI matches its Crossref record; 318 of the 318 references it cites were found in a registry or an index; none of the 186 sources its claims cite is checked for support yet.

Gut microbiota role in irritable bowel syndrome: New therapeutic strategies

Open access
Distrutti, Eleonora, Monaldi, Lorenzo, Ricci, Patrizia, Fiorucci, Stefano·2016·World Journal of Gastroenterology

Abstract

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

Registry

Crossref · 10.3748/wjg.v22.i7.2219

Cites

318 of 318 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 186 cited sources checked · 0 supported · 0 flagged

Show all 99 claims

  • It may state two separate claims as one. 31
  • Probably not a substantial claim. 9
  • The quote only partly states this claim. 1
38 of 38
  • 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”
9 of 9

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Citations

Cites

Items 201–318 of 318

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Research works printed but not linked: 4

  1. 10.1136/gut.45.2008.ii43 · DOI · Paper page
  2. 10.1111/j.1365-2982.2009.01447 · DOI
  3. 10.1111/j.1365-2982.2011.01783 · DOI
  4. 10.7326/0003-4819-145-8200610170-00004 · DOI

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Metadata

Authors
Distrutti, E., Monaldi, L., Ricci, P., & Fiorucci, S.
Affiliations
University of Perugia (IT)
Corresponding author
Distrutti, Eleonora
Venue
World Journal of Gastroenterology
Published
2016-02-21
Volume
22
Issue
7
Pages
2219-2241
ISSN
1007-9327 (ISSN-L)
OpenAlex
W2275770700
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
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

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