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Pr Giovanni Barbara: Irritable Bowel Syndrome and Gas

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Irritable Bowel Syndrome and gas-related symptoms

Pr Giovanni Barbara, Bologna



Gas, abdominal bloating are very common symptoms in patients with IBS. They affect about ninety percent of IBS population. And the pathogenesis is complicated because it includes changes in motility, sensitivity in the gut, but also, now, we know that there is a participation of the microbiota in this scenario, with the production of gas, which leads then to symptoms such as flatulence and abdominal bloating and distinction


In general, the data indicate that there is no excess of gas, but rather a wrong handling of the gas and this rely to hypersensitivity. But I think that the future in this field is to understand what type of gas is produced, and what type of gas is involved in this motility changes and this related hypersensitivity. This is a very interesting field of investigation and there is evidence, for exemple, that methane is related to lower gastro-intestinal transit in patients with IBS and other products, metabolic products of the bacteria and bacteria fermentation, could be involved in other symptoms in these patients.


There is very interesting data, from the United States, indicating that there is a correlation between certain TAXA and the bloating. And even, could be these types of changes even linked to a certain specific type of phenotype, and in other terms could be used as a biomarker of these symptoms.


I would not suggest, generally speaking, very restrictive diets in these patients because, if they are unbalanced, they could have long term effects on nutrition. So, I would not suggest this type of diets. I would suggest to modify a little bit the diet and avoid certain foods that are implicated in the symptoms, and also certain foods that are known to produce more gas and more symptoms, coming from the litterature, for example.


There are many ways we could modify the microbiota in these patients. Fecal transplantation is one way, but probably a little bit too invasive for these patients. The other way would be use of non-absorbable antibiotics. There are data indicating that these could improve the symptoms of the patients. But also, the easiest way and with the less side-effects would be the use of probiotics


Actually, the probiotics have been used impirically so far in these patients. Now, we know much better the way they work and the way they can modulate a sensitivity and motility, in general but also in patients with IBS. There are some good data indicating that the reduction in bifidobacteria is related to abdominal pain, so I would suggest to use bifidobacteria to manage pain, and lactobacilae to manage changes in bowel habit.


And one advantage of probiotics over other types of medications, is that probiotics have multiple effects and multiple sites of action as compared to drugs that generally target one single receptor or one single mechanism. And for a disease or a disorder which is characterized by multiple pathophysiological mechanisms, this could be an advantage



Previous editions


Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)

Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)
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