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IBS: Not Just a Grumpy Gut

by Kristina C. - November 2, 2015


Kristina Campbell is a freelance science writer who create quality content on gut microbiota for reputable online pharmacies Canada.

Photo Credit: by Kristina C
Photo Credit: by Kristina C
A patient walks into a doctor's office. The patient sits down and begins relating some toilet tales, terrible but true. The doctor listens, asks a few questions, orders a few tests. At the next visit, the patient finds out the name of her condition: irritable bowel syndrome (IBS).

'Irritable' seems a strange and imprecise word to use in a diagnosis, and indeed it conveys something about the disorder. In IBS, doctors can find nothing obviously wrong with the patient's organs or other body parts. As a functional disorder, IBS is diagnosed when, despite everything appearing physically normal, doctors give weight to the reported symptoms and acknowledge that they overlap with those of other patients.

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The symptoms of IBS – pain and cramping, bloating, and cycles of diarrhea and constipation, sometimes accompanied by anxiety or depression – can interfere with leading a normal, active life. Yet treatment is an inexact science. Individuals with IBS use a process of trial and error to figure out what lifestyle changes help improve their symptoms. When dietary changes and stress management don't work, some try medication and counseling.

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Recently though, a new line of scientific evidence is opening up the possibility that there is something biologically wrong in IBS, and that it's something we can measure. What was invisible to scientists in past decades has become visible through new technologies: the community of friendly and not-so-friendly bacteria that live in your digestive tract, together called the gut microbiota.

Scientists have been asking: Can we find a difference between healthy people and those with IBS if we analyze their gut microbiota? Several studies have shown that the answer is yes – IBS in human patients is indeed associated with an imbalanced bacterial community. The imbalance can look different ways, so it’s impossible to make a list of bacterial species that are always present or absent in the community. But the association opens up new ideas about biological correlates of IBS.

What scientists want to know next is whether or not the microbial imalance causes IBS symptoms. The answer to this is less obvious, but IBS probably arises because of a complex web of factors, including intestinal permeability (or "leaky gut"), endocrine imbalances, and a malfunctioning immune system. Some scientists believe, however, that a poor gut microbial community could be what kick-starts the whole disease process.

New diagnostic methods could be right around the corner as scientists zero in on exactly what bacteria in what proportions might signal the presence of IBS. Yet IBS is very broad and encompasses a lot of different symptoms – doctors call it heterogeneous. If the disease is heterogeneous, maybe it's not really a single disorder after all. Scientists say gut microbiota tests (basically, fecal samples) could soon reveal more than whether or not someone falls under the broad category of IBS; they could also reveal IBS subgroups that might be identified by different communities in the gut. It’s possible that different states of the microbiota could reflect the mechanisms of what is going wrong inside the body: for example, the microbiota might someday tell us that one group of people has a major problem with activation of the immune system, while another group has a breakdown in gut-brain communication.

Knowing that the microbiota are somehow involved in the disease, it's an exciting time for scientific testing of possible new treatments. One obvious question is whether adding species of good bacteria – probiotics – can improve symptoms. Initial studies show that some probiotics have an impact on IBS symptoms, but until researchers find out more about the gut microbiota imbalance in groups of IBS patients, they won't know exactly which live bacteria are most helpful in which amounts.

Gut microbiota analysis might even help researchers clarify how useful dietary change can be for those with IBS. Classically, patients tell their doctors about symptoms triggered by foods in their diet, whether it be wheat, bell peppers, or a greasy plate of french fries. But the diet that works for one person may not work for the next person, and maybe this is because the gut microbial community that a food encounters in the digestive tract is slightly different in each case.

The signs of change are all around: a Twitter group using the hashtag #notjustIBS publicly discusses re-examination of the term irritable bowel syndrome. Some physicians say they are reluctant to keep calling IBS a functional disorder. With just a little more patience, it will all pay off. Gut microbiota studies will tell us more about what's really going on in IBS, and will point the way toward personalized diagnosis and treatment.

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