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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2016; 22(7): 2219-2241
Published online Feb 21, 2016. doi: 10.3748/wjg.v22.i7.2219
Gut microbiota role in irritable bowel syndrome: New therapeutic strategies
Eleonora Distrutti, Lorenzo Monaldi, Patrizia Ricci, Stefano Fiorucci
Eleonora Distrutti, Lorenzo Monaldi, S.C. di Gastroenterologia ed Epatologia, Azienda Ospedaliera di Perugia, 06100 Perugia, Italy
Patrizia Ricci, Stefano Fiorucci, Dipartimento di Scienze Chirurgiche e Biomediche, Università degli Studi di Perugia, 06100 Perugia, Italy
Author contributions: Distrutti E, Monaldi L, Ricci P and Fiorucci S conceived and wrote the manuscript.
Conflict-of-interest statement: The Authors declare no conflict of interest
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Eleonora Distrutti, MD, S.C. di Gastroenterologia ed Epatologia, Azienda Ospedaliera di Perugia, 06100 Perugia, Italy. eleonoradistrutti@katamail.com
Telephone: +39-75-5784357 Fax: +39-75-5858120
Received: May 28, 2015
Peer-review started: June 1, 2015
First decision: October 14, 2015
Revised: December 5, 2015
Accepted: December 30, 2015
Article in press: December 30, 2015
Published online: February 21, 2016
Processing time: 247 Days and 13.7 Hours
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.

Keywords: Irritable bowel syndrome; Gut microbiota; Probiotics; Prebiotics; Synbiotics; Antibiotics; Fecal transplantation

Core tip: In the last decade, the gut microbiota has provided support to the concept that a disturbed intestinal ecology could 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. Probiotics appear an attractive option in terms of both efficacy and safety, while prebiotics, synbiotics and antibiotics still need formation. Fecal transplant has recently gained a new life as therapeutic option for those patients with an altered gut ecosystem, but data on IBS are scanty and randomized, placebo-controlled studies are required.